Invasive Pulmonary Aspergillosis as a Consequence of Influenza A Infection and Refractory Septic Shock: A Case Report

TL;DR

A 59-year-old man with severe influenza and septic shock developed invasive pulmonary aspergillosis after glucocorticoid treatment, highlighting risks of immunosuppression in critically ill patients.

Contribution

This case report highlights the increased risk of invasive pulmonary aspergillosis in critically ill patients receiving glucocorticoids for septic shock and severe influenza.

Findings

The patient developed invasive pulmonary aspergillosis confirmed by galactomannan and CT scan after glucocorticoid therapy.

The case illustrates the narrow therapeutic balance between hemodynamic benefits of glucocorticoids and opportunistic infection risks.

The patient progressed to multiorgan failure and died despite initial clinical improvement.

Abstract

Glucocorticoids are commonly administered in refractory septic shock because of their potential hemodynamic benefits. However, their immunosuppressive effects carry a recognized risk of opportunistic infections. In the presence of concomitant viral infections, such as influenza A, which themselves induce local immune dysregulation, this risk may be amplified. The combined immunological impairment can create a permissive environment for opportunistic pathogens, such as aspergillosis, potentially worsening clinical outcomes. We present the case of a 59‑year‑old man with type 2 diabetes mellitus, admitted to the intensive care unit (ICU) for severe community‑acquired pneumonia, complicated by euglycemic diabetic ketoacidosis, septic shock evolving into mixed shock (septic and cardiogenic), and acute respiratory failure. He received broad‑spectrum antimicrobial therapy and required invasive organ support, including invasive mechanical ventilation upon admission. Due to refractory respiratory failure and shock, he was referred and transferred to a reference center for veno‑arterial‑venous extracorporeal membrane oxygenation, where he was given seven days of systemic glucocorticoid therapy. After initial clinical and hemodynamic improvement, the patient developed invasive pulmonary aspergillosis (IPA) with cavitation, confirmed by positive galactomannan (3.1) on bronchoalveolar lavage and characteristic findings on thoracic CT scan. He progressed to multiorgan failure and died 24 days after admission to the ICU. This case highlights the narrow therapeutic balance between the hemodynamic benefits of glucocorticoids in refractory septic shock and the increased risk of opportunistic infections. IPA is increasingly recognized in critically ill patients without classical immunosuppression, particularly in the setting of severe influenza and corticosteroid exposure. Given the modest mortality benefit and potential for serious infectious complications, glucocorticoid therapy should be carefully individualized, with further studies needed to refine patient selection and treatment strategies.

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