A near fatal case of invasive aspergillosis

BACKGROUND: Invasive aspergillosis (IA) rarely presents with endobronchial nodules or pseudomembranes on bronchoscopy. We describe a case of invasive aspergillosis in a patient with systemic lupus erythematosus (SLE), in which a fungal etiology was suspected after visualization of scattered, white endobronchial nodules. CASE REPORT: A 36-year-old-female with history of SLE developed cardiorespiratory shock. Bronchoscopy indicated the presence of endobronchial lesions, and serologic studies were consistent with IA. Given high index of suspicion for fungal disease in an immunocompromised host, empiric antifungals were discontinued and voriconazole initiation resulted in a successful therapy. CONCLUSIONS: This case highlights the importance of a high index of suspicion for fungal diseases, especially among critically ill hosts with endobronchial lesions, who develop rapid cardio-respiratory impairment. Failure to recognize endobronchial patterns of fungal infection may lead to treatment delay and adverse clinical outcomes.