Invasive pulmonary aspergillosis with hydropneumothorax in a patient taking high-dose glucocorticoids

• Type of Material: Article
• Authors: Devika Dixit, Morehouse School of Medicine; Nelson T. Kuete, Morehouse School of Medicine; Philip Bene, Morehouse School of Medicine; Imran Khan, Morehouse School of Medicine; Gabriela Oprea-Ilies, Emory University School of Medicine; Gabriela Oprea, Emory University; Eric Flenaugh, Morehouse School of Medicine
• Language: English
• Date: 2020-01-01
• Publisher: International Scientific Information, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © Am J Case Rep, 2020.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.12659/AJCR.928499
• Title of Journal or Parent Work: American Journal of Case Reports
• Volume: 21
• Start Page: 1
• End Page: 5
• Keywords: Humans; Antifungal Agents; Female; Hydropneumothorax; Voriconazole; Glucocorticoids; Aged; Invasive Pulmonary Aspergillosis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Invasive pulmonary aspergillosis (IPA) is a severe form of the fungal infection with relatively high mortality rates. Risk factors that lead to IPA include immunosuppression through corticosteroid use. IPA complicated by hydropneumothorax is rare and its mechanism of formation is unknown. Case Report: A 72-year-old woman recently diagnosed with a right frontal meningioma that was managed with dexametha-sone presented with a new 3-day history of nonproductive cough, chest pain, and dyspnea and was managed for pneumonia. The patient failed to improve, prompting a follow-up computed tomography scan, which revealed a right middle lobe cavitary lesion. During the workup of this lesion, the patient’s hospital course was complicated by hemoptysis and development of a large right hydropneumothorax that was successfully managed with a chest tube. Despite initial resolution of hydropneumothorax, the patient developed a right apical pneumothorax that gradually worsened. Bronchoscopy culture revealed Aspergillus fumigatus, leading to the diagnosis of IPA, which was managed with intravenous voriconazole. Conclusions: Corticosteroid use with subsequent immunosuppression is a risk factor for developing IPA. Clinicians should include IPA in their differential diagnosis for respiratory infections in patients receiving corticosteroids. Although overall prognosis of IPA is poor, outcomes can be improved with early diagnosis, early empiric initiation of anti-fungals, and withdrawal of immunosuppressive therapy. IPA complicated by hydropneumothorax is a rare phe-nomenon with a poorly understood mechanism of formation. Based on our case, we propose a mechanism of hydropneumothorax formation from IPA.