Background: Invasive pulmonary aspergillosis (IPA) is a cause of morbidity and mortality in severely immunocompromised hosts. If not controlled, infection may spread from the lung to contiguous structures including the pleural space, pericardium, chest wall and mediastinal organs. Pneumomediastinum is a rare complication of IPA. We report a case of Aspergillus fumigatus pneumomediastinum in a patient with AIDS. Case Presentation: A 35-year-old woman presented with fatigue and a non-productive cough for 3 weeks. She denied chest discomfort or dyspnea. Her history was significant for AIDS (CD4+ T lymphocytes 8 cells/μL), recurrent oropharyngeal candidiasis and neutropenia. Examination revealed a cachectic woman. Temperature was 102.1oF, pulse 144/minute, respiratory rate 16/minute, and blood pressure 85/62 mmHg. Lungs were clear with no chest wall crepitus. White blood cell count was 1000 cells/μL, absolute neutrophil count 270 cells/μL, room air PaO2 93 mmHg, PCO2 40 mmHg. Chest radiograph revealed right upper lobe infiltrate and soft tissue emphysema. Chest CT demonstrated pneumomediastinum, multiple bilateral cavitary lesions and upper lobe opacities. Culture of bronchoalveolar lavage fluid showed Aspergillus fumigatus. Fine needle aspirate from a cavitary lesion showed Aspergillosis fumigatus. She was treated with systemic voriconazole. Follow-up chest radiograph after one week showed resolution of pneumomediastinum. However, her course deteriorated and she was discharged with hospice care. Conclusions: Invasive pulmonary aspergillosis (IPA) typically affects patients with quantitative and/or qualitative neutrophil defects. IPA is an uncommon opportunistic infection in AIDS occurring predominantly in those with neutropenia. Pneumomediastinum complicating IPA has been reported with neutropenia secondary to cytotoxic chemotherapy. Patients typically present with dyspnea, chest pain, and/or crackling sensation under the chest wall. To our knowledge this is the first case of pneumomediastinum secondary to IPA in a patient with AIDS. IPA should be considered in the differential diagnosis of pneumomediastinum in a highly immune compromised host.
Full conference title:
15th Annual Focus on Fungal Infections
- FFI 15th (2005)