title: Invasive Pulmonary Aspergillosis with Disseminated Infection in Immunocompetent Patient.
abstract: Invasive pulmonary aspergillosis (IPA) is a rare pathology with increasing incidence mainly in critical care settings and recently in immunocompetent patients. The mortality of the disease is very high, regardless of an early diagnosis and aggressive treatment. Here, we report a case of a 56 yr old previously healthy woman who was found unconscious at home and admitted to the emergency room with mild respiratory insufficiency. In the first 24 hours she developed an acute respiratory failure with new radiographic infiltrates requiring Intensive Care Unit admission. A severe obstructive pattern with impossibility of ventilation because of bilateral atelectasis was observed, requiring emergent venovenous extracorporeal membrane oxygenator device insertion. Bronchoscopy revealed occlusion of main bronchi, demonstrating by biopsy an invasive infection by Aspergillus fumigatus and A. flavus. Despite an aggressive treatment and vital support the patient had a fatal outcome. The forensic study confirms the diagnosis of IPA but also revealed the presence of disseminated aspergillosis.
authors.affiliation: Intensive Care Unit, Bellvitge University Hospital, Feixa Llarga, S/N, Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Moreno-González
authors.affiliation: Intensive Care Unit, Bellvitge University Hospital, Feixa Llarga, S/N, Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Ricart de Mesones
authors.affiliation: Bronchoscopy Department, Bellvitge University Hospital, Feixa Llarga, S/N, Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Rachid
authors.initials: R
authors.lastname: Tazi-Mezalek
authors.affiliation: Forensic Laboratory, Institute of Legal Medicine of Catalunya, Gran Via de les Corts Catalanes 111, 08075 Barcelona, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Marron-Moya
authors.affiliation: Bronchoscopy Department, Bellvitge University Hospital, Feixa Llarga, S/N, Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Rosell
authors.affiliation: Intensive Care Unit, Bellvitge University Hospital, Feixa Llarga, S/N, Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mañez
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000473:pathology; D001231:Aspergillus flavus; D001232:Aspergillus fumigatus; D001344:Autopsy; D001999:Bronchoscopy; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007121:Immunocompetence; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000473:pathology; D009393:Nephritis / Q000150:complications / Q000473:pathology; D020953:Neuroaspergillosis / Q000150:complications / Q000473:pathology; D013902:Radiography, Thoracic; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents