Two cases of COVID-19-associated pulmonary aspergillosis (CAPA)

Abstract

COVID-19-associated pulmonary aspergillosis (CAPA) is a recently recognized entity associated with the COVID-19 pandemic and known post-viral pneumonia complications. More data are awaited and there has been a recent consensus criteria published hoping to generate more research and registries to inform clinical decision-making. Nevertheless, it is clear that CAPA imposes a worsening disease course of COVID-19 pneumonia with added morbidity and mortality. We present two cases with differing outcomes managed within the limitations of our institute and make reference to the recent consensus criteria. We hope to highlight the importance of considering empirical treatment in the correct clinical context while awaiting the results of microbiological workup as ascertaining the diagnosis of proven CAPA is challenging in the real-world setting.

Keywords: COVID‐19; COVID‐associated pulmonary aspergillosis; aspergillosis; infection; inflammation.

FIGURE 1

Patient 1. Computed tomography (CT) thorax on day 8 of COVID‐19 infection (left panel) showed bilateral peri‐bronchovascular ground‐glass opacity. On day 40 of COVID‐19 infection (right panel), CT showed new cavitating lesion at the anterior segment of the right upper lobe with soft tissue within it. Consolidative changes were noted adjacent to the cavity

FIGURE 2

Patient 2. Computed tomography thorax on day 13 of COVID‐19 infection showed peripheral ground‐glass opacity with extensive pneumomediastinum and subcutaneous emphysema. Round heterogenous hyperdensity of the right upper lobe was noted raising the suspicion of infection (tuberculosis, fungal or bacterial) or malignancy, although less likely. On day 32 of COVID‐19 infection, a new cavitating lesion was noted at the right upper lobe where the nodule was seen. Previously seen ground‐glass opacity at the left lung appeared more dense