Discussion
Since the new pneumonia was first recognized in Wuhan, China, at the end
of 2019, the causative pathogen SARS-CoV-2 has been identified, and its
associated infection, COVID-19, has rapidly evolved worldwide. While
SARS-CoV-2 is responsible for severe pneumonia and ARDS, COVID-19 is
associated with a wide variety of extrapulmonary complications; many
other organs can be affected, including cardiovascular, immune, nervous,
and gastrointestinal systems, therefore, can be considered a systemic
disease. In addition to common bacteria and viruses, Aspergillus can
cause co-infection in COVID-19 patients, especially in severe/critical
illnesses. The possibility of co-infection with bacterial or fungal
infections is higher in patients who require follow-up in intensive care
units or require mechanical ventilation(4). Among the possible pathogens
in COVID-19 patients, Invasive
pulmonary aspergillosis (IPA ) carries
more attention to Aspergillus as it is challenging to diagnose and can
be associated with high morbidity and mortality. In particular,
respiratory samples for mycological studies such as fungal culture,
galactomannan test, and PCR from respiratory tract samples can help
early diagnosis. In our case, the culture results of the patient who was
followed up and treated with the non-intubated high flow for five days
in the intensive care unit during this period were typical.
All studies of COVID-19 fungal infections have reported that they occur
during COVID-19 infection, mostly 14 days after the onset of COVID-19
symptoms(5). In this case, a cavitary lesion in the right upper lobe was
observed in the fourth month of the patient’s COVID-19 treatment.
In COVID-19-associated pulmonary aspergillosis, diabetes,
immunosuppressive drug use, steroid therapy, and intubating are risk
factors for patients followed. It also increases the risk of pulmonary
aspergillosis in COVID-19 patients using IL-6 antagonists (6). In our
case, four vials of 162 mg tocilizumab were given on the 12th day of the
patient’s treatment. The patient had fibrotic lesions on the thorax CT,
and dyspnea continued. The patient was followed up under steroid and
colchicine treatment for about four months after discharge, and a
cavitary lesion in the right upper lobe was observed in the fourth-month
tomography.
Aspergillosis is one of the most common opportunistic fungal
co-infections caused by certain Aspergillus species, mainly affecting
immunocompromised individuals such as COVID-19 patients. It can
critically affect the respiratory system, leading to a mild/serious lung
infection known as pulmonary aspergillosis, a severe form of
aspergillosis that worsens over time and has no effective treatment.