Invasive pericardial and pulmonary aspergillosis by uncommon Aspergillus species in anti-interferon-γ autoantibody-associated immunodeficiency: a case report.

This case report describes a 51-year-old female patient who presented with dyspnea and was diagnosed with invasive aspergillosis affecting the pericardium and lungs, secondary to immunodeficiency syndrome caused by anti-interferon-γ autoantibodies. Diagnosis was established by pericardial tissue metagenomic next-generation sequencing (mNGS) identifying Aspergillus udagawae and serum anti-interferon-γ autoantibody testing (titer 1:2,500). Despite sequential antifungal therapy with voriconazole, isavuconazole, and amphotericin B, the patient developed progressive multifocal infection, including an abdominal wall abscess and mediastinal infection caused by Aspergillus siamensis, and ultimately died of multiple organ failure. This case highlights the diagnostic challenges and poor prognosis associated with this rare immunodeficiency syndrome and emphasizes the importance of early recognition, precise pathogen identification, and consideration of immunomodulatory therapy.