Invasive Aspergillosis After Non-Fatal Drowning

• Published in: International medical case reports journal 2020-01, Vol.13, p.77-83
• Main Authors: Koide, Shunichi, Hadano, Yoshiro, Mizuochi, Shinji, Koga, Hitoshi, Yamashita, Hisashi
• Format: Article
• Language: English
• Subjects: Accidental falls; acute respiratory distress syndrome; Adult respiratory distress syndrome; Analysis; Antibiotics; Aspergillosis; Biopsy; Blood pressure; Body temperature; Case Report; Case reports; CAT scans; Chronic obstructive pulmonary disease; Diagnostic imaging; drowning; Embolism; Embolisms; Fungal infections; Fungi; Heart rate; Hypertension; Hypothermia; Hypoxia; Immunocompetence; immunocompetent; Lung diseases; Lungs; Meropenem; Microscopy; Mortality; Mycoses; Neutropenia; Pathogenic microorganisms; Pathogens; Patients; Pneumonia; Pulmonary arteries; Pulmonary embolism; Pulmonary embolisms; Radiography; Respiratory distress syndrome; Respiratory failure; Respiratory insufficiency; Septic shock; Shock; Streptococcus infections; Sulbactam; Thyroid gland; Tomography; Veins & arteries; Ventilators; Voriconazole
• ISSN: 1179-142X; 1179-142X
• DOI: 10.2147/IMCRJ.S241234

Pneumonitis and pneumonia after non-fatal drowning are common and the pathogens involved are numerous. However, invasive aspergillosis after non-fatal drowning in immunocompetent individuals is relatively rare. Here, we report a case of invasive aspergillosis complicated by pulmonary embolism after non-fatal drowning that proved fatal. A 75-year-old Japanese man accidentally fell into a creek and was brought to a local hospital. His oxygenation steadily deteriorated to the point that he required intubation and mechanical ventilation. He was then transferred to the emergency department at our hospital. On arrival, he had severe respiratory dysfunction with diminished breath sounds. Radiography of the chest and computed tomography of the lungs showed diffuse bilateral infiltrates. The diagnosis was acute respiratory distress syndrome caused by aspiration pneumonitis as a result of non-fatal drowning and septic shock. Despite intensive care, the patient's hypoxia continued to worsen and he died on day 7. Computed tomography scans obtained at autopsy showed that both lungs were extensively infiltrated with effusion. An embolus was also detected in the right pulmonary artery. Microscopic analysis revealed diffuse filamentous fungi throughout the lungs, heart, stomach, thyroid gland, and the pulmonary embolus, which were identified as by culture. Invasive aspergillosis should also be considered in immunocompetent patients with severe respiratory failure after non-fatal drowning who do not respond to broad-spectrum antibiotics. Angioinvasive aspergillosis can even result in fatal pulmonary embolism; hence, early targeted testing for species and empiric intravenous voriconazole should be considered in such cases.