Table 2.
Characteristics of patients with putative invasive pulmonary aspergillosis.
| Patient 1 | Patient 2 | |
|---|---|---|
| Risk factors of severe COVID-19 | Moderate overwieght. | Moderate overweight, hypertension, diabetes. |
| Pre-existing pulmonary pathology | No | No |
| Risk factors of IPAa | No | No |
| Specific anti COVID-19 therapy | Hydroxychloroquine | Tocilizumab |
| Steroids use, 2 mg/kg/day | Yes | Yes |
| Vasopressor | Yes | Yes |
| Prone position | Yes | Yes |
| ECMO rescue | No | No |
| Renal replacement therapy | Yes | Yes |
| IPA diagnosis [3] Clinical criteria Serum galactomannan index BAL galactomannan index BAL or TA culture B-D-glucan, pg/ml Chest CT scan |
Fever refractory, deep hypoxemia 3.93 2.46 Aspergillus fumigatus 62 Excavations, nodular lesions |
Recrudescent fever, worsening respiratory insufficiency 0.78 - Aspergillus fumigatus 706 Excavations, nodular lesions with halo sign |
| Outcome | Death | Death |
IPA: invasive pulmonary aspergillosis; ECMO: extracorporeal membrane of oxygenation; BAL: bronchoalveolar lavage; TA: tracheal aspirate; CT: computed tomography.
a
The risk factors of IPA have been defined by European Organization for Research and Treatment of Cancer (EORTC) and include: deep neutropenia for more than 10 days, Hematologic malignancy, receipt of an allogenic stem cell transplant or a solid organ transplant, daily use of corticosteroids for more than 3 weeks, severe acute graft-versus-host disease and treatments with recognized T-cell or B-cell immunosuppressants [5].