Invasive Pulmonary Aspergillosis and Nocardia Pneumonia in a Pediatric Patient With Chronic Lung Disease: A Case Report.

This case illustrates the susceptibility of pediatric patients with chronic lung disease, here, a 3-year-old male with structural airway injury and impaired mucociliary clearance from recurrent aspiration (due to Chiari II malformation and spinal dysgenesis), to life-threatening polymicrobial co-infections, even without classic immunodeficiency. The child was admitted with acute respiratory failure and sepsis; imaging demonstrated necrotizing pneumonia and pneumatoceles; bronchoalveolar lavage confirmed ∗Aspergillus∗ galactomannan positivity and ∗Nocardia∗ species, warranting broad antimicrobial therapy and mechanical ventilation. Diagnosis of invasive aspergillosis and treatment initiation were delayed; despite therapy, he developed multiorgan failure and died. This highlights how chronic lung disease predisposes children to catastrophic fungal-bacterial synergies and reinforces the value of early bronchoscopy for targeted treatment. Advanced disease with structural damage portends poor outcomes, underscoring the need for enhanced surveillance in this high-risk cohort.