SHM Converge Scientific Abstract ePoster Gallery-An Idiosyncratic Duo: A Case of Covid Associated Pulmonary Aspergillosis (Capa) in an Immunocompetent Patient

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This case report describes a 58-year-old unvaccinated, immunocompetent woman who developed COVID-associated pulmonary aspergillosis (CAPA) after severe COVID-19 pneumonia. She initially presented with 10 days of worsening nonproductive cough, shortness of breath, fatigue, weakness, poor appetite, and anxiety. Her history included remote asthma and obesity, but no major immunocompromising condition.<br /><br />On admission, she was tachypneic with diminished breath sounds. Laboratory studies showed elevated inflammatory markers and marked hyperglycemia with ketoacidosis. Initial chest CT demonstrated bilateral peripheral ground-glass opacities and consolidations typical of COVID-19 pneumonia. Despite treatment with remdesivir, tocilizumab, and a 21-day dexamethasone course, her condition worsened. Repeat CT showed progression to multifocal consolidation with early cavitation, raising concern for superimposed fungal infection.<br /><br />Workup for other fungal and infectious causes was negative, but Aspergillus antigen returned positive, supporting CAPA. She was started on a 3-month course of isavuconazole, along with Bactrim prophylaxis and a steroid taper. She was ultimately discharged on high-flow nasal cannula oxygen, with significant improvement in inflammatory markers.<br /><br />The presentation emphasizes that respiratory viral infections can damage airway epithelium and impair ciliary clearance, enabling Aspergillus invasion even in patients without classic immunosuppression. CAPA may be difficult to recognize because symptoms are nonspecific, onset is variable, and diagnosis is challenging due to limited sensitivity of serum galactomannan and concerns about bronchoscopy aerosolization. The authors stress the importance of identifying risk factors such as corticosteroid and anti-IL-6 therapy and maintaining suspicion for CAPA in worsening COVID-19 patients.

Asset Subtitle

Rudiona Hoxhaj

Meta Tag

Author List Rudiona Hoxhaj, Sridevi Agasthi, Usha Anand

Category Clinical Vignettes

Concept COVID-19

Concept Pulmonary Aspergillosis

Concept COVID-19-associated pulmonary aspergillosis

Concept Risk Factor

Concept Airway Damage

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Rudiona Hoxhaj

Track Adult

Keywords

COVID-associated pulmonary aspergillosis

CAPA

severe COVID-19 pneumonia

Aspergillus antigen

isavuconazole

corticosteroid therapy

tocilizumab

ground-glass opacities

pulmonary cavitation

fungal infection

COVID-19

Pulmonary Aspergillosis

COVID-19-associated pulmonary aspergillosis

Risk Factor

Airway Damage