Usuda Daisuke, Kato Masashi, Sugawara Yuto, Shimizu Runa, Inami Tomotari, Tsuge Shiho, Sakurai Riki, Kawai Kenji, Matsubara Shun, Tanaka Risa, Suzuki Makoto, Shimozawa Shintaro, Hotchi Yuta, Osugi Ippei, Katou Risa, Ito Sakurako, Mishima Kentaro, Kondo Akihiko, Mizuno Keiko, Takami Hiroki, Komatsu Takayuki, Oba Jiro, Nomura Tomohisa, Sugita Manabu
Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan.
Department of Sports Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan.
World J Clin Cases. 2023 Sep 16;11(26):6280-6288. doi: 10.12998/wjcc.v11.i26.6280.
Coronavirus disease 2019 (COVID-19)-associated invasive pulmonary aspergillosis presents a diagnostic challenge due to its non-specific clinical/ imaging features, as well as the fact that the proposed clinically diagnostic algorithms do not necessarily apply to COVID-19 patients. In addition, . is a rare cause of opportunistic life-threatening fungal infections. Disseminated infection in an immunocompromised host is intractable, with a high likelihood of resulting mortality. To our knowledge, this is the first case of secondary pulmonary infection by () and () during systemic steroid treatment for COVID-19.
A 62-year-old male was transported to our hospital by ambulance with a complaint of fever and dyspnea. We established a diagnosis of pneumococcal pneumonia, complicated with COVID-19 and septic shock, together with acute renal failure. He was admitted to the intensive care unit, to be treated with piperacillin/tazobactam, vancomycin, and 6.6 mg per day of dexamethasone sodium phosphate, along with noradrenaline as a vasopressor, ventilator management, and continuous hemodiafiltration. His condition improved, and we finished the vasopressor on the fifth hospital day. We administered dexamethasone for ten days, and finished the course of treatment. On the eleventh day, patient respiratory deterioration was observed, and a computed tomography scan showed an exacerbation of bilateral ground-glass-opacity-like consolidation, together with newly appeared cavitary lesions in the lung. we changed antibiotics to meropenem plus vancomycin. In addition, a fungal infection was considered as a possibility based on microscopic findings of sputum, and we began coadministration of voriconazole. However, the pneumonia worsened, and the patient died on the seventeenth day of illness. Later, and were identified from sputum collected on the twelfth day. It was believed that he developed a cell-mediated immune deficiency during COVID-19 treatment, which led to the complication of pneumonia caused by the above-mentioned fungi, contributing to his death.
Because early initiation of intense antifungal therapy offers the best chance for survival in pulmonary fusariosis, computed tomography scans and appropriate microbiologic investigations should be obtained for severely immunocompromised patients.
2019冠状病毒病（COVID-19）相关的侵袭性肺曲霉病因其非特异性的临床/影像学特征，以及所提出的临床诊断算法不一定适用于COVID-19患者，而带来了诊断挑战。此外，……是危及生命的机会性真菌感染的罕见原因。免疫功能低下宿主中的播散性感染难以治疗，死亡率很高。据我们所知，这是首例在COVID-19全身类固醇治疗期间发生的由（）和（）引起的继发性肺部感染病例。
一名62岁男性因发热和呼吸困难由救护车送至我院。我们诊断为肺炎球菌肺炎，合并COVID-19和感染性休克，以及急性肾衰竭。他被收入重症监护病房，接受哌拉西林/他唑巴坦、万古霉素治疗，每天使用6.6毫克地塞米松磷酸钠，同时使用去甲肾上腺素作为血管升压药、进行呼吸机管理和持续血液透析滤过。他的病情有所改善，在住院第5天停用了血管升压药。我们给予地塞米松治疗10天，完成了疗程。在第11天，观察到患者呼吸功能恶化，计算机断层扫描显示双侧磨玻璃样实变加重，同时肺部新出现空洞性病变。我们将抗生素更换为美罗培南加万古霉素。此外，根据痰液的显微镜检查结果考虑可能存在真菌感染，我们开始联合使用伏立康唑。然而，肺炎病情恶化，患者在发病第17天死亡。后来，从第12天采集的痰液中鉴定出了（）和（）。据信，他在COVID-19治疗期间出现了细胞介导的免疫缺陷，导致上述真菌引起肺炎并发症，最终导致死亡。
由于早期开始强化抗真菌治疗为肺镰刀菌病患者提供了最佳生存机会，因此对于严重免疫功能低下的患者，应进行计算机断层扫描和适当的微生物学检查。
