Chronic necrotizing aspergillosis after COVID-19: a case report

Abstract

COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a concerning complication in critically ill patients. This report highlights a rare instance of chronic necrotizing aspergillosis (CNA) developing after COVID-19 in a patient with no classical risk factors. A 50-year-old Iranian male, with no underlying comorbidities, presented with severe COVID-19 infection requiring intensive care unit admission and treatment with short-course high-dose corticosteroids and immunomodulatory therapies followed by a 20-day tapering regimen after discharge. Four months after recovery, he developed hemoptysis and chest imaging revealed a newly developed cavitary lesion. Aspergillus fumigatus was isolated from bronchoalveolar lavage fluid. Antifungal therapy with voriconazole led to marked clinical and radiologic improvement. This case illustrates the potential for chronic necrotizing aspergillosis to develop following severe COVID-19, particularly in patients with prior corticosteroid exposure. Early recognition and treatment are essential to avoid complications. Pulmonary aspergillosis should be considered in post-COVID patients with delayed cavitary lung lesions. Although unrecognized CAPA during the acute phase cannot be completely excluded, the delayed onset and progressive cavitary evolution in this case were most consistent with chronic necrotizing aspergillosis.