SHM Converge Scientific Abstract ePoster Gallery-Double Trouble: Covid-19 Pneumonia Concurrent With Covid-19 Associated Pulmonary Aspergillosis (Capa)

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This case report describes COVID-19 associated pulmonary aspergillosis (CAPA), a serious fungal superinfection that can complicate severe COVID-19 pneumonia and increase mortality, especially in ICU patients.<br /><br />A 52-year-old unvaccinated man with asthma and obstructive sleep apnea presented 10 days after testing positive for COVID-19 with worsening shortness of breath. On arrival, he was profoundly hypoxemic with an oxygen saturation of 65% on room air and required high-flow nasal cannula. Exam showed scattered bilateral crackles. Laboratory testing revealed leukopenia, and chest X-ray demonstrated multifocal bilateral opacities consistent with COVID-19 pneumonia. He was treated with dexamethasone and remdesivir and admitted to the MICU for acute hypoxemic respiratory failure. Baricitinib was added, and empiric antibiotics were started for possible bacterial superinfection, but cultures were initially negative.<br /><br />Four days later, the patient developed new leukocytosis and worsening dyspnea. Repeat sputum culture grew Aspergillus fumigatus, leading to initiation of voriconazole. Chest CT showed pneumomediastinum, a small pneumothorax, subcutaneous emphysema, and diffuse ground-glass opacities. Despite treatment, he continued to require supplemental oxygen and was discharged nearly two months later still needing high-flow nasal cannula.<br /><br />The report emphasizes that CAPA may present subtly, not only with classic symptoms such as fever, chest pain, hemoptysis, or pleural rub, but also with nonspecific worsening respiratory status. Key risk factors include severe COVID-19 lung injury and prolonged steroid use. Clinicians should have a low threshold to pursue fungal evaluation in critically ill COVID-19 patients who deteriorate without another clear explanation. Diagnosis can be supported by culture of bronchoalveolar lavage or tracheal aspirate and galactomannan testing. Voriconazole remains first-line therapy.

Asset Subtitle

Komal Khoja

Meta Tag

Author List Komal Khoja, Marisa Tobes, Pinky Jha, Yasir Abdelgadir

Category Clinical Vignettes

Concept COVID-19-associated pulmonary aspergillosis

Concept Voriconazole

Concept Severe COVID-19

Concept Pulmonary Aspergillosis

Concept Lung Injury

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Komal Khoja

Track Adult

Keywords

COVID-19 associated pulmonary aspergillosis

CAPA

Aspergillus fumigatus

voriconazole

severe COVID-19 pneumonia

ICU patient

fungal superinfection

acute hypoxemic respiratory failure

galactomannan testing

dexamethasone

COVID-19-associated pulmonary aspergillosis

Voriconazole

Severe COVID-19

Pulmonary Aspergillosis

Lung Injury