Pulmonary aspergillosis occurred during the acute phase of COVID-19 in a patient on hemodialysis

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  • COVID-19 の急性期に肺アスペルギルス症を発症した血液透析患者の1 例
  • COVID-19 ノ キュウセイキ ニ ハイ アスペルギルスショウ オ ハッショウ シタ ケツエキ トウセキ カンジャ ノ 1レイ

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Abstract

<p>An 85-year-old male patient with type 2 diabetes mellitus had been undergoing hemodialysis for end-stage renal disease for 2.7 years. He was complicated with hypertension and bronchial asthma. He presented with a fever without a cough or dyspnea. A SARS-CoV-2 antigen rapid test was performed because COVID-19 was prevalent. The antigen test was positive, and he was admitted to our hospital. Laboratory tests showed a white blood cell count of 4,830/μL, a neutrophil count of 2,801/μL, a platelet count of 8.4x104/μL, and a C-reactive protein level of 1.04 mg/dL. Chest computed tomography (CT) showed ground glass opacities (GGOs) in the bilateral lungs. On day 2, he presented with worsening dyspnea and required oxygen. CT showed worsening of the GGOs. The patient was transferred to the designated medical institution for infectious diseases and treated with remdesivir, dexamethasone, and favipiravir. His symptoms and the GGOs improved rapidly. He returned to our hospital on day 14. CT performed on day 14 showed a new nodular shadow with a small cavity in the left upper lobe. On day 27, the nodular shadow and cavity had enlarged, and the cavity contained an area of hyperdense soft-tissue attenuation. On day 28, serum galactomannan（ GM) antigen and β-D-glucan tests were positive. Treatment with voriconazole for pulmonary aspergillosis was initiated from day 36. His serum GM antigen level decreased, and CT showed improvement of the pulmonary lesion. When hemodialysis patients with COVID-19 show new nodular shadows with cavities in the lung, it is necessary to consider pulmonary aspergillosis.</p>

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