key: cord-0005717-2ifeo9s4
authors: Pietsch, Urs; Müller-Höcker, Christina; Enzler-Tschudy, Annette; Filipovic, Miodrag
title: Severe ARDS in a critically ill influenza patient with invasive pulmonary aspergillosis
date: 2016-05-13
journal: Intensive Care Med
DOI: 10.1007/s00134-016-4379-3
sha: eec9669766bbd1e01ed8a9b5636e9613ceaf0a9b
doc_id: 5717
cord_uid: 2ifeo9s4

nan

A 63-year-old previously healthy woman presented to the hospital with fever, breathlessness, and abdominal pain for 6 days. She reported a history of successfully treated breast cancer 5 years ago (surgery and chemotherapy) and 37 pack-years of smoking. In the following days she developed a severe ARDS. Bronchoscopy showed (Fig. 1a) . The performed transbronchial biopsy, BAL cultures, and PCR revealed influenza A, parainfluenza 4 virus, and an invasive aspergillus (IA) fumigatus infection (Fig. 1b) . Serum aspergillus galactomannan antigen levels were 1.5 ng/mL. CTs of the thorax showed progressive bilateral cavities over the following days (Fig. 1c, d) . Despite full intensive care, including antiviral and antifungal treatment, the patient died of the severe ARDS.

Risk factors are use of corticosteroids (CS) or smoking. However, influenza viruses have been reported to cause cell-mediated destruction of airway epithelium and disruption of normal mucociliary clearance, fostering colonization and invasion with Aspergillus even in immunocompetent H1N1 patients [1] . The occurrence of IA in the ICU usually entails a poor prognosis. Therefore, our threshold to actively search for invasive aspergillosis in critically ill influenza patients should be low. Only early diagnosis and treatment might improve the high mortality rate. 

Consent was obtained for the use of information and images. The patient's identity has been kept confidential.

None to declare.

Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study