SHM Converge Scientific Abstract ePoster Gallery-Break the Mold! Fresh Look at Subacute Invasive Pulmonary Aspergillosis.

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This case describes subacute invasive pulmonary aspergillosis (SIPA), a rare form of Aspergillus lung infection that can occur in patients with chronic structural lung disease, even with only mild immunosuppression. An 87-year-old man with bullous emphysema, pulmonary fibrosis, and rheumatoid arthritis treated with low-dose prednisone presented with one month of worsening exertional dyspnea, productive cough with brown sputum, and weakness. He had recently been treated for presumed community-acquired pneumonia with antibiotics but did not improve.<br /><br />On admission, he was malnourished, tachypneic, and had leukocytosis and elevated procalcitonin. Chest CT showed a large right upper lobe cavity with a ball-like intraluminal opacity and thick-walled cavitations in the right middle lobe, findings concerning for aspergillosis. Serum galactomannan was negative, but bronchoalveolar lavage culture later grew Aspergillus niger. After failing multiple antibiotic courses, he was started on voriconazole, but his condition continued to worsen with progressive shortness of breath, weight loss, and fatigue. He chose hospice and died 13 days after admission.<br /><br />The report emphasizes that SIPA is difficult to diagnose because symptoms are nonspecific, imaging can be variable, and laboratory tests such as serum galactomannan and respiratory cultures have limited ability to distinguish infection from colonization. Tissue biopsy is often not feasible in frail patients, and clear diagnostic criteria are lacking. Awareness of SIPA is especially important in patients with underlying lung damage, as timely antifungal treatment may improve outcomes.

Asset Subtitle

Palina Sudnik

Meta Tag

Author List Palina Sudnik

Category Clinical Vignettes

Concept Subacute Invasive Pulmonary Aspergillosis

Concept Aspergillosis

Concept Structural Lung Disease

Concept Mild Immunosuppression

Concept Subacute Respiratory Symptoms

Distinguished Non-Finalist

Presenter Organization St. Luke's University Health Network

Presenting Author Palina Sudnik

Track Adult

Keywords

subacute invasive pulmonary aspergillosis

Aspergillus niger

chronic structural lung disease

bullous emphysema

pulmonary fibrosis

rheumatoid arthritis

prednisone

lung cavity

galactomannan

voriconazole

Subacute Invasive Pulmonary Aspergillosis

Aspergillosis

Structural Lung Disease

Mild Immunosuppression

Subacute Respiratory Symptoms