CHEST Guidelines-A-61-Year-Old-Man-With-Influenza-Pneumonia-and-New

A-61-Year-Old-Man-With-Influenza-Pneumonia-and-New

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A 61-year-old man presented with severe respiratory symptoms, including fever, purulent sputum, and hemoptysis. An active smoker with no previous medical history, he was diagnosed with influenza pneumonia and severe emphysema. Initial treatment in the ICU included piperacillin-tazobactam, azithromycin, oseltamivir, and corticosteroids. Despite treatment, his condition worsened, and he experienced new symptoms, such as increased leukocytosis and hemoptysis. A subsequent CT scan revealed new cavitary infiltrates. This led to suspicion of a secondary bacterial infection, prompting a change to imipenem, linezolid, and levofloxacin.<br /><br />Bronchoscopic evaluation revealed endobronchial erythema, necrosis, and pseudomembrane formation, indicating a serious fungal infection. Histopathologic analysis showed necrotic material and fungal elements, leading to a diagnosis of Influenza-associated Pulmonary Aspergillosis (IAPA), a condition marked by the rapid onset of fungal infection following influenza pneumonia. IAPA is a severe complication often overlooked but common among critically ill influenza patients, with significant mortality rates if not promptly addressed.<br /><br />Unfortunately, the patient was started on antifungal treatment with voriconazole only on day 9, but his condition continued to deteriorate, leading to multiorgan failure. Despite intensive care measures, the family elected for comfort care, given the poor prognosis.<br /><br />Key clinical insights include the importance of early recognition and treatment of IAPA, avoiding routine use of corticosteroids in influenza pneumonia due to increased risk, and the role of serum galactomannan as a diagnostic marker. Early suspicion and testing for IAPA can significantly improve patient outcomes, highlighting the necessity for awareness among clinicians managing influenza-complicated cases.

Keywords

Influenza-associated Pulmonary Aspergillosis

IAPA

influenza pneumonia

secondary bacterial infection

antifungal treatment

voriconazole

corticosteroids

serum galactomannan

multiorgan failure

critical care