Proven pulmonary aspergillosis in a COVID-19 patient: A case report

Sadegh  Khodavaisy; Nasim Khajavirad; Seyed Jamal   Hashemi; Alireza  Izadi; Seyed Ali   Dehghan Manshadi; Alireza  Abdollahi; Amir  Aliramezani; Elahe   Sasani; Mahsa   Abdorahim; Reyhaneh Sadat   Kiyaeie; Zohre   Khosravany; Muhammad  Ibrahim Getso; Mohammadreza   Salehi

doi:10.18502/cmm.7.2.7031

Sadegh Khodavaisy Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Nasim Khajavirad Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Seyed Jamal Hashemi Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Alireza Izadi Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Seyed Ali Dehghan Manshadi Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Ira
Alireza Abdollahi Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Amir Aliramezani Central Laboratory, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Elahe Sasani Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Mahsa Abdorahim Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
Reyhaneh Sadat Kiyaeie Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Zohre Khosravany Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Muhammad Ibrahim Getso Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Salehi Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cmm.7.2.7031

Keywords: Aspergillosis Aspergillus tubingensis COVID-19

Abstract

Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection.

Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole.

Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients