Aspergillus tubingensis pneumonia with pulmonary oxalosis in a virologically suppressed person with HIV: A case report.
Ryoko Sekiya, Tatsuya Inukai, Mihoko Yotsumoto et al.
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Case in brief
A man in his late sixties with virologically suppressed HIV and a CD4 count of 368/μL developed cough, then fever and dyspnea requiring hospitalization. CT showed bilateral pneumonia and a right upper-lobe cavity. PCR-based analysis with DNA sequencing identified Aspergillus tubingensis; susceptibility testing showed reduced susceptibility to multiple azoles. Voriconazole alone failed, while voriconazole plus micafungin brought partial clinical improvement. Pulmonary oxalosis developed. After partial radiological improvement, he was discharged on long-term voriconazole but required home oxygen for chronic respiratory insufficiency. He died after 2.5 years; autopsy showed extensive pulmonary fibrosis, traction bronchiectasis, and hyaline membrane formation.
What made this case unusual
Infection occurred despite virologic suppression and a preserved CD4 count. The isolate had reduced susceptibility to multiple azoles, and the course was complicated by pulmonary oxalosis and substantial chronic lung damage.
Diagnostic / clinical pearl
Consider invasive aspergillosis in a person with HIV even when viral suppression and CD4 status appear reassuring; species identification and susceptibility testing can be important when azole therapy fails.