The curious case of aplastic anemia: a fatal triple co-infection with Aspergillus, Mucorales, and Nocardia.

BACKGROUND

Concurrent opportunistic infections are rare but can lead to life-threatening complications in patients with hematologic disorders. Immunosuppression, particularly severe neutropenia, significantly increases the risk of invasive fungal and bacterial infections. We report a 34-year-old female with chronic hepatitis B initially presented with pancytopenia. Subsequent bone marrow evaluation revealed aplastic anemia, and she subsequently received immunosuppressive therapy. During hospitalization, she developed multiple infectious episodes, including fever, pulmonary nodular lesions, and oral mucosal lesions. PCR assays and histopathology confirmed a rare triple co-infection involving Aspergillus, Mucorales, and Nocardia species. Although multimodal therapy combining antifungal and antibacterial agents and surgical intervention was initiated, persistent neutropenia prevented complete infection resolution.

CONCLUSION

Co-infection with Aspergillus, Mucorales, and Nocardia in immunocompromised patients, particularly those with malignancy or receiving corticosteroid therapy, requires early recognition and appropriate therapy to reduce complications and mortality. This case underscores that persistent, profound neutropenia remains an insurmountable barrier to recovery, highlighting that immune reconstitution is as critical as antimicrobial therapy in such scenarios.

CLINICAL TRIAL NUMBER: Not applicable.