# Diagnostic Challenge and Treatment Delay in Drowning‐Associated Pneumonia: A Case of Combined Aeromonas, Legionella, and Aspergillus Infection

## TL;DR

This paper presents a case of a rare combined infection after drowning, emphasizing the need for early diagnosis and treatment of multiple pathogens.

## Contribution

The paper highlights the importance of early bronchoscopy to detect opportunistic fungal infections in drowning-associated pneumonia.

## Key findings

- The patient had a combined infection with Aeromonas, Legionella, and Aspergillus after freshwater drowning.
- Delayed bronchoscopy led to late detection of Aspergillus, contributing to the patient's death.
- Immediate broad-spectrum treatment and early bronchoscopy are critical for managing such infections.

## Abstract

Drowning‐associated pneumonia often involves multiple types of pathogens, including Aeromonas hydrophila, Legionella spp., and fungi. We report the case of an 82‐year‐old man who developed a rare combined infection with these three organisms after freshwater drowning. Initial therapy for typical aspiration pneumonia was ineffective. Although A. hydrophila and Legionella pneumophila were subsequently identified and targeted, the patient’s condition failed to improve. While chest computed tomography on the 11th day of hospitalization revealed worsening infiltrates and new cavity lesions, bronchoscopy was delayed until Day 13 due to circulatory instability. Subsequently, Aspergillus fumigatus was identified from bronchial lavage. Despite starting targeted antimicrobial and antifungal therapy late, the patient died on Day 21. This case highlights that in freshwater drowning, immediate broad‐spectrum empirical treatment covering high‐risk environmental bacteria and Legionella is essential. Furthermore, if initial therapy is ineffective or radiological progression occurs, early bronchoscopy must be performed to identify secondary or opportunistic pathogens, including Aspergillus or other fungi to prevent deadly delays in diagnosis.