Horiuchi Hiroshi, Utada Syusuke, Shinomiya Yoshie, Miyagawa Takao, Sogo Azusa, Niida Shoko, Okano Hiromu, Suzuki Naoya, Otsuka Tsuyoshi, Miyazaki Hiroshi, Furuya Ryosuke
Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, JPN.
Cureus. 2022 Jul 26;14(7):e27281. doi: 10.7759/cureus.27281. eCollection 2022 Jul.
Invasive pulmonary aspergillosis (IPA) has been reported to occur secondary to coronavirus disease 2019 (COVID-19), and the condition has been termed COVID-19-associated pulmonary aspergillosis (CAPA). We diagnosed two severe COVID-19 cases with multiple cavitary lung lesions and chronic pulmonary aspergillosis (CPA) on days 58 and 48 of admission, respectively, with gradual improvement in the respiratory status. Both patients were positive for precipitating antibodies (APAb). We chose oral itraconazole (ITCZ) for both patients because of its convenience in terms of long-term treatment. Cavitary lesions diminished after ITCZ administration. The risk factors for pulmonary aspergillosis in both patients were determined to be steroid pulse therapy, use of baricitinib, diabetes mellitus (DM), ICU admission, long hospital stay, and the use of broad-spectrum antibiotics. Pulmonary aspergillosis must be suspected in patients with severe COVID-19, even if they are asymptomatic, because not only IPA but also CPA can occur following COVID-19. Therefore, oral ITCZ may be a treatment option for CPA following COVID-19.
侵袭性肺曲霉病（IPA）据报道继发于2019冠状病毒病（COVID-19），这种情况被称为COVID-19相关肺曲霉病（CAPA）。我们分别在两名重症COVID-19患者入院第58天和第48天诊断出伴有多个肺空洞病变和慢性肺曲霉病（CPA），其呼吸状况逐渐改善。两名患者的沉淀抗体（APAb）均呈阳性。由于长期治疗方便，我们为两名患者均选择了口服伊曲康唑（ITCZ）。给予ITCZ后，空洞病变缩小。两名患者发生肺曲霉病的危险因素被确定为类固醇脉冲疗法、巴瑞替尼的使用、糖尿病（DM）、入住重症监护病房、住院时间长以及使用广谱抗生素。对于重症COVID-19患者，即使无症状也必须怀疑肺曲霉病，因为COVID-19后不仅可能发生IPA，还可能发生CPA。因此，口服ITCZ可能是COVID-19后CPA的一种治疗选择。
