Atypical Presentation of Aspergillus niger Infection in the Oral Cavity as a Prediction of Invasive Pulmonary Aspergillosis in a Patient with COVID-19: Case Report and Literature Review

Abstract

Coinfections between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens such as Aspergillus have become challenging, as well as being associated with high morbidity and mortality in patients with COVID-19. Aspergillus niger is a common environmental mold. Before the emergence of COVID-19, it was considered a very rare cause of invasive pulmonary aspergillosis (IPA), occurring mainly in immunocompromised patients. The aim of this study was to describe a very rare case of IPA caused by A. niger found in the oral cavity of a mechanically ventilated COVID-19 patient. A. niger detected in the gingival pocket was diagnosed earlier than in the bronchial lavage, and without treatment, passed into the lungs of the patient, causing serious complications. The swab from the oral cavity of mechanically ventilated COVID-19 patients can be a predictor of the subsequent severity of inflammatory lesions and the development of suspected IPA.

Keywords: Aspergillus niger; coronavirus disease 2019; gingival pocket; invasive pulmonary aspergillosis; oral cavity; severe acute respiratory syndrome coronavirus 2.

Figure 1

(A) Lung X-ray (Day 1). Bilateral pneumonia. (B) Aspergillus niger. Conidiophores of Aspergillus niger stained with lactophenol cotton blue (LCB), magnified 400×, provided by Zuzanna Tokarz MSc. (C) Lung HRCT (Day 15). Left lung atelectasis (1. right lung: suspected invasive pulmonary aspergillosis; 2. halo sign in early stage; 3. consolidation; 4. bronchiectasis; 5. ground-glass opacities).