Successful treatment of severe influenza-associated pulmonary aspergillosis with invasive tracheobronchitis and bronchial asthma using combination antifungals and omalizumab: A case report.

Influenza-associated pulmonary aspergillosis (IAPA) is a secondary pulmonary aspergillosis following influenza, predominantly occurring in critically ill influenza patients requiring intensive care unit admission. It carries a high mortality rate, particularly in patients with invasive Aspergillus tracheobronchitis (IATB), where the fatality rate can reach up to 90%. This article reports a case of severe IAPA complicated by IATB and bronchial asthma and successfully treated with combination therapy of high dose antifungals and biologic. The patient had failed multiple antifungal therapies at another hospital and rapidly progressed to respiratory failure, necessitating endotracheal intubation before being transferred to our institution. Through a treatment regimen comprising a loading dose of caspofungin, triazole antifungals, inhaled amphotericin B, and omalizumab, the patient was successfully weaned off mechanical ventilation, extubated, and eventually discharged in improved condition. During treatment, voriconazole blood concentration was found to be extremely low, and CYP2C19 genotyping suggested a rare rapid/ultrarapid metabolizer variant.