Aspergillus species are ubiquitous environmental molds that healthy humans encounter daily without any adverse effects. However, these molds can cause a range of diseases in immunocompromised individuals, collectively known as invasive aspergillosis. These diseases can affect the sinuses, tracheobronchial tree, lungs, skin, or disseminate. The most common form of invasive aspergillosis is invasive pulmonary aspergillosis, which has high morbidity and mortality rates and requires prompt diagnosis and treatment. A severe form, known as angioinvasive pulmonary aspergillosis, occurs when mold hyphae invade the pulmonary arteries and cause necrosis and hemorrhage of the lung parenchyma. We present such a case in a 17-year old boy with acute myeloid leukemia who developed pulmonary pseudoaneurysms as a complication. The patient was initially admitted to the hospital for scheduled chemotherapy. Several complications occurred, including neutropenic fevers, cough, and pleuritic chest pain, despite broad-spectrum antibiotics. Initial imaging with CT pulmonary angiography showed multifocal nodules and masses with surrounding groundglass opacities. Serum aspergillosis galactomannan and Fungitell were strongly positive. Bronchoalveolar lavage was not performed due to profound anemia and thrombocytopenia. Initial treatment included dual-antifungal therapy with continued treatment upon discharge. Follow-up CT exams demonstrated complications with multiple pseudoaneurysms necessitating repeat hospitalizations, coil embolization, and lobectomy. This case demonstrates classic CT findings of angioinvasive pulmonary aspergillosis, including the "halo" and “air crescent” signs. In our case, the patient developed complications with pulmonary pseudoaneurysms that required multiple interventions. Prompt diagnosis and treatment of this condition is important due to the life-threatening implications. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Cristobal Alberto, Martinez-sicari Jorge, Vorona Gregory, Jones Kathryn, Austin Frances, Mahdi Eman

Keywords: Invasive aspergillosis, Pseudoaneurysm, Immunocompromised