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Case Reports
. 2020 Dec;30(4):101039.
doi: 10.1016/j.mycmed.2020.101039. Epub 2020 Aug 20.

Fatal aspergillosis complicating severe SARS-CoV-2 infection: A case report

F Schein  1 , H Munoz-Pons  1 , C Mahinc  2 , R Grange  3 , P Cathébras  1 , P Flori  4
Affiliations
Case Reports

Fatal aspergillosis complicating severe SARS-CoV-2 infection: A case report

F Schein et al. J Mycol Med. 2020 Dec.

Abstract

As aspergillosis is a well-known complication of severe influenza, we suggest that SARS-CoV-2 might be a risk factor for invasive aspergillosis (IA). We report the case of an 87 year-old woman, with no history of immune deficit, admitted in our emergency room for severe respiratory distress. Coronavirus disease 2019 (COVID-19) diagnosis was confirmed by a SARS-CoV-2 reverse transcriptase polymerase chain reaction (PCR) on nasal swab. On day 14, pulmonary examination deteriorated with haemoptysis and a major increase of inflammatory response. A computed tomography (CT) scan revealed nodules highly suggestive of IA. Aspergillus antigen was found highly positive in sputum and blood, as was Aspergillusspp PCR on serum. Sputum cultures remained negative for Aspergillus. This patient died rapidly from severe respiratory failure, despite the addition of voriconazole. Considering SARS-CoV-2 acute respiratory distress syndrome (ARDS) as an acquired immunodeficiency, we report here a new case of "probable" IA based on clinical and biological arguments, in accordance with the last consensus definition of invasive fungal disease. On a routine basis, we have detected 30% of aspergillosis carriage (positive culture and antigen in tracheal secretions) in critically ill patients with COVID-19 in our centre. Further studies will have to determine whether sputum or tracheal secretions should be systematically screened for fungal investigations in intensive care unit (ICU) COVID-19 patients to early diagnose and treat aspergillosis.

Keywords: Antigen; Coronavirus Disease 2019 (COVID-19); Diagnosis; Invasive aspergillosis; Serology.

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Figures

Fig. 1
Fig. 1
Transverse (A) and coronal (B) CT images of the thorax showing three nodular opacities in the upper lobes, and the lower left lobe (white arrows) with a partial circumferential rim of radiolucent airspace, with air crescent sign, formed as a result of separation of devitalised necrotic centre (star) from the surrounding opaque rim. Bilateral posterior ground-glass opacities (black arrows) are one of the radiological patterns of infection due to Sars-CoV-2.
Fig. 2
Fig. 2
Serological profile with LDBIO Diagnostics WB assay: a two-specific bands pattern, compared to a seroconversion profile in a patient with influenza-induced respiratory failure complicated by invasive aspergillosis. T+ = positive control from patients with a chronic serological profile.
See this image and copyright information in PMC

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