Invasive Pulmonary Aspergillosis in Children: A Case Report and Literature Review

Patient: Female, 15-year-old Final Diagnosis: Febrile neutropenia • invasive pulmonary aspergillosis Symptoms: Cough • SOB Medication: — Clinical Procedure: — Specialty: Oncology • Pediatrics and Neonatology • Radiology OBJECTIVE: Unusual clinical course BACKGROUND: Invasive pulmonary aspergillosis (IPA) is the major cause of mortality and morbidity in immunocompromised patients with prolonged neutropenia and is associated with poor prognosis. Multiple factors are associated with an increased risk of invasive aspergillosis, including persistent neutropenia, impaired lymphocyte engraftment following bone marrow transplantation, cytomegalovirus disease, respiratory virus infection, cytotoxic chemo-therapy, and Aspergillus colonization. Unfortunately, attempts at fungal isolation are often unsuccessful. CASE REPORT: We describe a 15-year-old girl with a known case of acute myeloid leukemia (AML) with unusual cause of chest infection accompanied with a persistent radiological finding that worsened with time despite multiple levels of intervention. The optimal treatment was unclear, given that all cultures were negatives and the condition did not improve. Very interesting radiological findings will be elaborated in this case. Despite the typical radiological findings, we struggled to confirm the underlying cause of lung infection, which was demonstrated to be Aspergillus fumigatus by thoracoscopy and lavage. Eventually, when the patient started to improve, catastrophic bleeding occurred, confirming the angio-invasive nature of this organism. CONCLUSIONS: IPA is still associated with very high morbidity and mortality. A high index of suspicion is needed for such cases. We recommend lavage on the third or fourth day of febrile neutropenia illness in patients who did not show clear improvement with the standard neutropenia protocol, and we suggest considering combined antifungal therapies at an earlier time point. IPA is angio-invasive and can lead to catastrophic bleeding. Earlier surgical intervention might be considered, especially in refractory localized aspergillus.