Confirmed Invasive Pulmonary Aspergillosis and COVID-19: the value of postmortem findings to support antemortem management

Abstract

We present postmortem evidence of invasive pulmonary aspergillosis (IPA) in a patient with severe COVID-19. Autopsies of COVID-19 confirmed cases were performed. The patient died despite antimicrobials, mechanical ventilation, and vasopressor support. Histopathology and peripheral blood galactomannan antigen testing confirmed IPA. Aspergillus penicillioides infection was confirmed by nucleotide sequencing and BLAST analysis. Further reports are needed to assess the occurrence and frequency of IPA in SARS-CoV-2 infections, and how they interact clinically.

FIGURE 1:. Histopathology of the lung. A. Numerous hyphae and fungal spores shown by H&E staining. Microscopic cavitation surrounded by numerous hypahes and fungal spores (40x). B. Well-defined Aspergillus head, allowing the visualization of phialides and conidia, with numerous fungal spores (PAS, 400x). C. Well-defined aspergillary structure showing conidiophore, aspergillary vesicle, phialides, and conidia, as well as several hyphae of regular diameter, some with septations and dichotomous branches (Gomori-Grocott, 400x). D. Bronchopneumonia with alveoli filled by neutrophils (H&E, 400x). E. Fibrin thrombi occluding a medium-sized artery (H&E, 400x) F. Squamous metaplasia in alveolar epithelial cells (H&E, 400x).