Pulmonary and central nervous system aspergillosis in a patient with COVID-19 infection

Abstract

Introduction. Patients with COVID-19 infection are vulnerable to a variety of serious complications, including invasive fungal infections such as aspergillosis. Because pulmonary aspergillosis is difficult to confirm with perfect confidence, it has been classified as “proven,”“probable,” and “possible.” We present a patient with COVID-19 infection in whom a “probable” pulmonary aspergillosis was complicated by hematogenous spread into brain with formation of multiple abscesses. Case outline. A 67-year-old female was diagnosed with COVID-19 infection using polymerase chain reaction (PCR) from a nasopharyngeal swab. The patient had never been vaccinated before. Despite standard therapy and noninvasive oxygen support, the patient’s health deteriorated one month following the onset of the disease, with chest discomfort, cough, and hemoptysis. Thoracic computed tomography (CT) revealed bilateral infiltrative lesions with varying diameters of cavities, primarily in the left lung, as well as modest effusions in both pleural spaces. Aspergillus hyphae were isolated from tracheobronchial aspirates. Despite therapy with Amphotericin B, which was only available antifungal medication at the time, the patient fell into a coma. A CT scan of the skull revealed several infiltrative lesions inside the brain, some with cavities suggestive to metastatic abscesses, most likely of fungal etiology (Aspergillus) as a result of hematogenous spread of pulmonary aspergillosis. Despite therapy and all other precautions, the patient died. The autopsy was not carried out. Conclusion. In addition to other complications, COVID-19 patients may develop pulmonary aspergillosis, which can be fatal because of the possibility of hematogenous spread to the brain.

Keywords

• covid-19
• invasive pulmonary aspergillosis
• brain