Kitayama Takaaki, Tone Kazuya, Makimura Koichi, Takagi Masamichi, Kuwano Kazuyoshi
Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, JPN.
Division of Mycosis Control, Teikyo University Institute of Medical Mycology, Tokyo, JPN.
Cureus. 2023 Mar 16;15(3):e36212. doi: 10.7759/cureus.36212. eCollection 2023 Mar.
A 55-year-old man was admitted for coronavirus disease 2019 (COVID-19)-related respiratory failure. He was treated with corticosteroids and tocilizumab in the intensive care unit. was isolated from his sputum on admission. However, no radiological findings suggesting pulmonary aspergillosis were seen on chest computed tomography (CT). Since the fungus had merely colonized in airways, antifungal drugs were not administered immediately. On day 19 of hospitalization, a high (1→3)-β-D-glucan (BDG) level was noted. A CT scan on day 22 revealed consolidations with a cavity in the right lung. was isolated from his sputum again. Thus, we diagnosed the patient with COVID-19-associated pulmonary aspergillosis (CAPA) and started voriconazole. After the treatment, BDG levels and radiological findings were noted to improve. In this case, tocilizumab probably had a critical role in developing the disease. Although antifungal prophylaxis therapy for CAPA is not well established, this case shows that detecting in airway specimens before the disease onset possibly implies a high risk of developing CAPA and is an indicator of antifungal prophylaxis.
一名55岁男性因2019冠状病毒病（COVID-19）相关呼吸衰竭入院。他在重症监护病房接受了皮质类固醇和托珠单抗治疗。入院时从其痰液中分离出[具体真菌名称未给出]。然而，胸部计算机断层扫描（CT）未发现提示肺曲霉病的影像学表现。由于该真菌仅在气道内定植，未立即给予抗真菌药物。住院第19天，发现（1→3）-β-D-葡聚糖（BDG）水平升高。第22天的CT扫描显示右肺有实变伴空洞形成。再次从其痰液中分离出[具体真菌名称未给出]。因此，我们诊断该患者为COVID-19相关肺曲霉病（CAPA）并开始使用伏立康唑治疗。治疗后，BDG水平和影像学表现均有改善。在本病例中，托珠单抗可能在疾病发展中起关键作用。尽管CAPA的抗真菌预防治疗尚未明确，但该病例表明在疾病发作前在气道标本中检测到[具体真菌名称未给出]可能意味着发生CAPA的高风险，是抗真菌预防的一个指标。
