COVID-19-associated pulmonary aspergillosis: a case report from the COVID-19 surveillance program.

Abstract

A 72-year-old male was brought to the hospital following a motorcycle crash and was admitted for multiple trauma management. His initial course of hospitalization was complicated by mild hypoxemia and altered mental status. Respiratory workup and imaging were consistent with SARS-CoV-2 pneumonia. He completed a five-day course of remdesivir and a ten-day course of dexamethasone. Twenty days later, he developed a low-grade fever. His chest computerized tomography (CT) showed gas and fluid containing parenchymal collection in the anteromedial right middle lobe measuring up to 4.8 cm, most consistent with a pulmonary abscess. Antimicrobial treatment was started. The patient became hypoxic and was intubated and mechanically ventilated. Bronchoalveolar lavage fluid was positive for galactomannan assay, a diagnostic marker for possible aspergillosis. A repeat chest CT showed a cavitary lesion with a positive air crescent sign, a common CT finding of invasive pulmonary aspergillosis. The patient was diagnosed with COVID-19-associated pulmonary aspergillosis and was started on antifungal treatment. He improved clinically and was successfully extubated.