Komal Khoja, BA; Samira Samant, MD; Devesh Kumar, BS; Pinky Jha, MD, MPH
Introduction: Severe complications due to COVID-19 are a growing concern. We present a case of COVID-19 pneumonia with development of a superimposed COVID-19–associated pulmonary aspergillosis.
Case Presentation: A 52-year-old unvaccinated male with a history of asthma and sleep apnea presented with progressive dyspnea 10 days after COVID-19 diagnosis. Worsening respiratory function despite broad-spectrum antibiotics and negative cultures prompted a repeat respiratory culture that revealed Aspergillus; voriconazole was initiated.
Discussion: The risk of COVID-19–associated pulmonary aspergillosis is highest in patients who are immunosuppressed or who receive corticosteroids to treat COVID-19 infection. Subtle and atypical presentations can be seen; our patient had only mild leukocytosis and progressive dyspnea with a negative initial respiratory culture. COVID-19–associated pulmonary aspergillosis is associated with high morbidity and mortality; thus, prompt diagnosis and treatment may confer a survival benefit.
Conclusions: Despite the subtle presentation and variable radiographic findings in COVID-19– associated pulmonary aspergillosis, a low clinical threshold for workup is crucial to a timely diagnosis and treatment.