A 56-Year-Old Male Farmer From China With Severe Fever With Thrombocytopenia Syndrome and Pulmonary Aspergillosis: A Case Report and Review of Literature.

BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by the Dabie bandavirus (commonly known as SFTS virus, or SFTSV). SFTSV-induced immunosuppression during infection renders patients highly susceptible to invasive pulmonary aspergillosis. SFTS-associated pulmonary aspergillosis (SAPA) presents major therapeutic challenges and is linked to drastically worsened outcomes, including high mortality. This report aims to highlight the diagnostic and therapeutic challenges of SAPA and emphasize the value of early diagnosis using metagenomic next-generation sequencing (mNGS). CASE REPORT We report a case of a previously healthy 56-year-old male farmer admitted with SFTS. On hospital day 3, when only mild cough had begun, mNGS of both blood and sputum concurrently detected Aspergillus fumigatus alongside SFTSV. This very early, pre-radiographic diagnosis prompted immediate targeted therapy with voriconazole and favipiravir. Despite this, imaging showed progressive pulmonary infiltrates with cavitation. The clinical course was further complicated by severe acute respiratory syndrome coronavirus 2 co-infection, but the patient recovered with intensive care and was discharged on day 24. A review of 13 literature-reported SAPA cases revealed a mortality rate of 30.77% (4/13). CONCLUSIONS SAPA is a severe, rapidly progressive complication of SFTS with high mortality, typically emerging 1-2 weeks after onset. This case highlights the importance of early diagnosis using rapid methods such as mNGS and the need for timely antifungal intervention to improve patient outcomes. Early antifungal therapy in high-risk patients is crucial.