Severe Recurrent COVID-Associated Pulmonary Aspergillosis: A Challenging Case

Abstract

We report a rare case of severe COVID-19-associated pulmonary aspergillosis presenting as invasive pulmonary aspergillosis and subsequently invasive tracheobronchial aspergillosis during hospitalization in a critically ill patient who developed a further Aspergillus infection after home discharge. He needed readmission to the ICU and mechanical ventilation. We therefore strongly encourage a high degree of attention to fungal complications, even after viral recovery and ICU discharge.

Keywords: COVID-19; critically ill patient; mechanical ventilation; pulmonary aspergillosis; tracheostomy.

Figure 1

Timeline of disease progression and patient’s clinical course. Legend: thin red arrows pointing up show the response to the treatment initiated due to changes within the clinical condition of the patient, which are represented by thin blue arrows pointing down.

Figure 2

Chest CT scan at emergency department admission. Legend: complete collapse of left upper lobe and lingula and partial collapse of left lower lobe are shown, with main bronchial branches obstructed by clots (arrow in (A)). A pseudo-aneurysm was also found in the upper anterior left lobe (arrow in (B)).

Figure 3

Lung bedside ultrasound evaluation and chest CT scan during ICU stay. Legend: with ultrasound, oval hypoechoic mass of about 5.2 cm × 4.4 cm in left upper anterior zone, characterized by some hyperechoic spots inside (Figure 3, yellow box), suggestive of hematoma. This finding was confirmed by chest CT scan, which showed a hyperdense bloody mass.

Figure 4

CT chest scan showing a lesion suspected as aspergilloma, as pointed out by blue arrow. Legend: blue arrow shows lesions suggestive of aspergilloma.