Atypical Presentation of <i>Aspergillus niger</i> 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

• coronavirus disease 2019
• severe acute respiratory syndrome coronavirus 2
• invasive pulmonary aspergillosis
• <i>Aspergillus niger</i>
• oral cavity
• gingival pocket