TYPE: Case Report
TOPIC: Critical Care
INTRODUCTION: COVID-19 infection may moderately or severely compromise the patient´s immunity.
CASE PRESENTATION: A case of CAPA in a 38 years female whose COVID PCR was positive. She did not have host factors and clinically responded to 6 weeks voriconazole. She was presented with fever, tachypnea, tachycardia, pleuritic Chest pain and High oxygen requirement .she developed ARDS and mechanically ventilated. CRP, procalcitonin. Blood culture, sputum bacterial, fungal cultures, and autoimmune markers were negative. Mycoplasma antibodies and Quantiferon test were also negative. HRCT chest showed the halo sign (Figure 1). Voriconazole IV was initiated. CT PE excluded pulmonary embolism.Diagnosis of CAPA was challenging because of absence of host factor, negative fungal culture, nonavailability of galactomanan test .Despite that she was managed as a possible CAPA with good response to voriconazole. The diagnosis depended on refractory fever, refractory hypoxia after a period of adequate antibiotics, negative procalcitonin, halo sign in HRCT, negative bacterial cultures, positive serum aspergillus antibodies and positive (1–3)-β-D-glucan. Prone positioning and (APRV) led to improved oxygenation. Intravenous 3 days pulse dose methylprednisolone started on the day of progressive HRCT chest.After (SPT) the patient was extubated. Voriconazole tab continued for 3 more weeks and prednisone tab 10 mg tab for 10 days. HRCT chest after 2 weeks showed improvment
DISCUSSION: Patients may be moderately immunocompromised after COVID-19 infection hence, susceptible to CAPA. Early detection of radiologic finding in HRCT may warrant early initiation of antifungal if CAPA is clinically suspected.
CONCLUSIONS: Serum Aspergillus IgG may be of clinical value indiagnosing IPA
DISCLOSURE: Nothing to declare.
KEYWORD: COVID, HYPOXIA, CAPA, IPA, HALO SIGN, SOLITARY LUNG CONSOLIDATION