Medicina pulmonar y respiratoria

Fatal Recurrent Invasive Pulmonary Aspergillosis: A Rare Co-infection Case with Pulmonary Embolism in COPD

Abstract

Shanshan Su, Ying Zhou, Yupeng Xie, Min Ye, Chengshui Chen and Yuping Li

Background: Patients with severe chronic obstructive pulmonary disease (COPD) are becoming one of the main risk factors for invasive pulmonary aspergillosis (IPA). Furthermore, COPD patients are at a high risk for pulmonary embolism (PE). Both these two conditions, when COPD is concomitant with IPA or PE, carry a poor prognosis. The coexistence of these three fatal diseases is rare.

Case presentation: We report a case of recurrent IPA concomitant with PE in a 76-year-old male with GOLD 4 COPD, who presented as non-specific hypoxemia and dyspnea and did not respond to the antifungal therapy. This case shows that patients should be treated until resolution of all clinical and radiographic manifestations in case of reactivation and that 10 weeks of antifungal therapy may be inadequate. For the treatment failure of antifungals, we presume PE would aggravate ischemia and hypoxia in the fungal-infected tissue, thus limiting the access of antifungal drugs. It deserves further research to improve the efficacy of antifugals in IPA patients concurrent with PE.

Conclusion: A diagnosis of PE should be considered in COPD patients resistant to appropriate therapy such as bronchodilators and antibiotics. On the other hand, physicians should be alert for the relapse of IPA in COPD patients with prior IPA presented as fever and dyspnea not respond to appropriate therapy, and conduct diagnostic procedures promptly.