Chronic Pulmonary Aspergillosis During Convalescence From Severe COVID-19 Treated With Oral Itraconazole: A Report of Two Cases

Invasive pulmonary aspergillosis (IPA) has been reported to occur secondary to coronavirus disease 2019 (COVID-19), and the condition has been termed COVID-19-associated pulmonary aspergillosis (CAPA). We diagnosed two severe COVID-19 cases with multiple cavitary lung lesions and chronic pulmonary a...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2022-07, Vol.14 (7)
Main Authors: Horiuchi, Hiroshi, Utada, Syusuke, Shinomiya, Yoshie, Miyagawa, Takao, Sogo, Azusa, Niida, Shoko, Okano, Hiromu, Suzuki, Naoya, Otsuka, Tsuyoshi, Miyazaki, Hiroshi, Furuya, Ryosuke
Format: Article
Language:English
Subjects:
Allergy/Immunology
Antibiotics
Antifungal agents
Antigens
Aspergillosis
Body temperature
Bronchoscopy
Case reports
Consciousness
Coronaviruses
COVID-19
Drug therapy
Dyspnea
Emergency Medicine
Fever
Fungal infections
Fungi
Hypoxia
Infectious Disease
Long term health care
Lungs
Medical imaging
Ostomy
Oxygen saturation
Oxygen therapy
Patients
Pneumonia
Respiration
Severe acute respiratory syndrome coronavirus 2
Staphylococcus infections
Ventilation
Ventilators
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Summary:Invasive pulmonary aspergillosis (IPA) has been reported to occur secondary to coronavirus disease 2019 (COVID-19), and the condition has been termed COVID-19-associated pulmonary aspergillosis (CAPA). We diagnosed two severe COVID-19 cases with multiple cavitary lung lesions and chronic pulmonary aspergillosis (CPA) on days 58 and 48 of admission, respectively, with gradual improvement in the respiratory status. Both patients were positive for Aspergillus-precipitating antibodies (APAb). We chose oral itraconazole (ITCZ) for both patients because of its convenience in terms of long-term treatment. Cavitary lesions diminished after ITCZ administration. The risk factors for pulmonary aspergillosis in both patients were determined to be steroid pulse therapy, use of baricitinib, diabetes mellitus (DM), ICU admission, long hospital stay, and the use of broad-spectrum antibiotics. Pulmonary aspergillosis must be suspected in patients with severe COVID-19, even if they are asymptomatic, because not only IPA but also CPA can occur following COVID-19. Therefore, oral ITCZ may be a treatment option for CPA following COVID-19.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.27281