Double Trouble: COVID-19 Pneumonia Concurrent With COVID-19-Associated Pulmonary Aspergillosis.

INTRODUCTION

Severe complications due to COVID-19 are a growing concern. We present a case of COVID-19 pneumonia with development of a superimposed COVID-19-associated pulmonary aspergillosis.

CASE PRESENTATION: A 52-year-old unvaccinated male with a history of asthma and sleep apnea presented with progressive dyspnea 10 days after COVID-19 diagnosis. Worsening respiratory function despite broad-spectrum antibiotics and negative cultures prompted a repeat respiratory culture that revealed Aspergillus; voriconazole was initiated.

DISCUSSION: The risk of COVID-19-associated pulmonary aspergillosis is highest in patients who are immunosuppressed or who receive corticosteroids to treat COVID-19 infection. Subtle and atypical presentations can be seen; our patient had only mild leukocytosis and progressive dyspnea with a negative initial respiratory culture. COVID-19-associated pulmonary aspergillosis is associated with high morbidity and mortality; thus, prompt diagnosis and treatment may confer a survival benefit.

CONCLUSIONS

Despite the subtle presentation and variable radiographic findings in COVID-19- associated pulmonary aspergillosis, a low clinical threshold for workup is crucial to a timely diagnosis and treatment.