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There is only one case about a COPD patient concomitant with PE and chronic necrotizing pulmonary aspergillosis (CNPA) in literature .We report a case of recurrent IPA coexistent with PE, with a fatal outcome in an old male with COPD.Yu-Ping Li MD, Department of Pulmonary Medicine The First Affiliated Hospital of Wenzhou Medical University Wenzhou, Zhejiang 325015, China Tel: (86) 0577-5557-9273 Fax: (86) 0577-5557-9273 E-mail: [email protected] Received date: February 20, 2016; Accepted date: April 14, 2016; Published date: April 18, 2016 Citation: Su S, Zhou Y, Xie Y, Ye M, Chen C, et al.(2016) Fatal Recurrent Invasive Pulmonary Aspergillosis: A Rare Co-infection Case with Pulmonary Embolism in COPD. doi:10.4172/2161-105X.1000333 Copyright: © 2016 Su S, et al.As symptoms improved, he withdrew the drugs with no doctors’ order and follow-up.Comorbidities included hypertension and diabetes mellitus with no drug use.This case shows that patients should be treated until resolution of all clinical and radiographic manifestations in case of reactivation and that 10 weeks of antifungal therapy may be inadequate.For the treatment failure of antifungals, we presume PE would aggravate ischemia and hypoxia in the fungal-infected tissue, thus limiting the access of antifungal drugs.
Subsequently, a diagnosis of ‘acute exacerbation of COPD’ was made and antibiotics (imipenem) and methylprednisolone were administered, which gradually improve the symptoms in 2 weeks.
At present, approximately 50% of all invasive aspergillosis are found in neutropenic hosts .
But patients with severe chronic obstructive pulmonary disease (COPD) are becoming one of the main risk groups for invasive pulmonary aspergillosis (IPA) .
Figure 1: Chest CT scan (2012-9-28) revealed a cavity in right upper lobe (white arrow, size 2.8 × 2.1 cm), which led to the diagnosis of probable IPA and COPD, combined with the positive finding in sputum culture for A. On admission, he was conscious but cyanosed, with moderate nutrition status, body temperature 38?
, blood pressure 107/74 mm Hg, respiratory rate 22 breaths/min, heart rate 116 beats/min and oxygen saturation 90% on room air.