Successful treatment of chronic pulmonary aspergillosis in a patient with early pulmonary tuberculosis and COVID-19: a case report

Alexandre Albuquerque Bertucci; Cláudia Elizabeth  Volpe-Chaves; Diogo Melo Mendo; Úrsulla Vilella Andrade; Mara Luci Goncalves Galiz Lacerda; James Venturini; Bruna Abdul Ahad  Saad; Caroline Tieppo Flores de Oliveira; Sandra Maria do Valle Leone de  Oliveira; Anamaria Mello Miranda  Paniago

doi:10.5826/mrm.2024.989

Successful treatment of chronic pulmonary aspergillosis in a patient with early pulmonary tuberculosis and COVID-19: a case report

Authors

Alexandre Albuquerque Bertucci Maria Aparecida Pedrossian University Hospital, Campo Grande, Mato Grosso do Sul, Brazil; Graduate Program in Infectious and Parasitic Diseases at the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; https://orcid.org/0009-0004-2641-2633
Cláudia Elizabeth Volpe-Chaves Maria Aparecida Pedrossian University Hospital, Campo Grande, Mato Grosso do Sul, Brazil; Hospital Regional de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; https://orcid.org/0000-0002-3004-2039
Diogo Melo Mendo Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0002-3965-6272
Úrsulla Vilella Andrade Graduate Program in Infectious and Parasitic Diseases at the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0002-6932-1692
Mara Luci Goncalves Galiz Lacerda Hospital Regional de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0002-5061-6589
James Venturini Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0003-0035-2439
Bruna Abdul Ahad Saad Hospital Regional de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0001-7479-2838
Caroline Tieppo Flores de Oliveira Hospital Regional de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0002-1430-2881
Sandra Maria do Valle Leone de Oliveira Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0002-8960-6716
Anamaria Mello Miranda Paniago Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil https://orcid.org/0000-0002-8925-7712

DOI: https://doi.org/10.5826/mrm.2024.989

Keywords:

Pulmonary tuberculosis, chronic pulmonary aspergillosis, Sars-Cov-2, COVID-19, aspergilloma

Abstract

Introduction: Chronic pulmonary aspergillosis (CPA) often develops in residual lesions of pulmonary tuberculosis (PTB). Every year, 112,000 to 160,000 people worldwide will develop post-PTB CPA. The simultaneous occurrence of CPA with the first episode of PTB is rare. During the COVID-19 pandemic, COVID-19-
associated invasive aspergillosis (CAPA) occurred in patients receiving high doses of corticosteroids and
mechanical ventilation. However, CPA and COVID-19 are rarely reported simultaneously. This case study presents a patient with CPA in the first episode of PTB during hospitalization for COVID-19. The favorable evolution is highlighted, including the resolution of the cavitation and fungal ball with appropriate and early treatment.
Case presentation: A 48-year-old female patient from the Central West of Brazil was admitted with a history of cough, yellow sputum, fever, and significant weight loss for two months. The respiratory symptoms worsened one week before admission. She tested positive for COVID-19 by RT-PCR. She had a history of hypertension and diabetes. Clinical examination revealed tachypnea, slurred speech, and hypoxia. She presented with hyperglycemia, obesity, hypertension, and an episode of hemoptysis. Chest CT revealed cavitation in the right upper lobe with a 45 mm aspergilloma, multifocal morning opacities, and nodular opacities. Laboratory tests confirmed the PTB with positive sputum for acid-fast bacilli and positive culture for Mycobacterium tuberculosis. The sputum culture also showed Aspergillus spp. She received early treatment for bacterial pneumonia with ceftriaxone, dexamethasone, enoxaparin, an anti-TB regimen, and itraconazole. There was a progressive clinical improvement and the patient was discharged after 15 days. She completed six months of anti-TB therapy and 13 months of itraconazole treatment for CPA, with complete resolution of the cavitation and aspergilloma.
Discussion and conclusion: This case study presents a unique case of CPA that manifested as simple aspergilloma and was diagnosed concurrently with the initial episode of PTB in a COVID-19 patient with obesity, hypertension, and diabetes. Remarkably, the fungal ball and cavitation regressed spontaneously. The favorable clinical and radiological results highlight the importance of comprehensive treatment approaches for concurrent respiratory infections and emphasize the need to investigate CPA and PTB during COVID-19 hospitalization.

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