Case presentation
The patient was a 31-year-old housewife. She had a severe form of Covid-19, diagnosed clinically and biologically (positivity of the SARS-CoV-2 RT-PCR test on a nasopharyngeal swab), evolving favourably under a well-conducted treatment including Azithromycin for 5 days, Ceftriaxone, Dexamethasone and Enoxaparine for 14 days. She had no other specific history, including no smoking, no alcoholism, no diabetes and no history of pulmonary tuberculosis. Her history dates back to 3 months after her hospitalization by progressively worsening shortness of breath (dyspnea), left chest pain of a heavy feeling, without radiation, evolving in a context of altered general condition such as asthenia and weight loss. She received various treatments such as antibiotics, tonics and bronchodilators, without any improvement. On the other hand, she developed a productive wet cough with non-fetid yellowish sputum. Then, she was re-hospitalized for respiratory discomfort, chest pain, cough and altered general condition. The clinical examination on admission objectified a decrease in oxygen saturation at 90% in ambient air (96% with oxygen 4 litres per minute), a respiratory rate at 20 cycles per minute, a heart rate at 75 beats per minute, a blood pressure at 130/60 mmHg and a temperature at 36.9°C. She was asthenic and her body mass index was 20 kg/m2. The physical examination had nothing particular. The electrocardiogram was unremarkable. Biological examinations revealed an inflammatory syndrome with a hyperleukocytosis of 22.9 x 109/l, predominantly neutrophils (79%), a red blood cell sedimentation rate of 24 mm and a C-Reactive Protein of 13.9 mg/l. Other biological tests were normal, with a D-dimer level of 348 ng/l, a glycaemia of 5.37 mmol/l and a negative HIV serology. The SARS-CoV-2 RT-PCR test performed on suspicion of a long Covid was negative. SARS-CoV-2 serology was positive for Ig G. The GeneXpert MTB/RIF sputum tests for pulmonary tuberculosis were negative. Sputum cyto-bacteriological tests were also negative. The chest CT scan without injection of contrast agent revealed a cavitary lesion in the apical segment of the left upper lobe, within which was an opacity surmounted by an “air crescent”; typical of fungal ball lesion, suggestive of an aspergilloma (Figure 1). After that, the mycological examination revealed mycelial filaments evoking Aspergillus. It should be noted that aspergillosis serology was not available in the country. On the basis of the clinical, biological, and scan evidences, the diagnosis of probable post-Covid-19 aspergillosis was made. The patient was put on an antifungal treatment with Itraconazole 200 mg per day. The clinical course after 14 days of treatment was favourable with disappearance of dyspnea, reduction of cough, chest pain and asthenia. She was discharged from hospital at the third week of treatment. However, she complained of persistent moderate chest pain. The chest CT scan after 2 months of treatment showed disappearance of the aspergilloma (Figure 2a) with a residual cavity surrounded by parenchymal destruction, suggestive of chronic necrotizing aspergillosis and onset of homolateral fibrosis (Figure 2b). Thus, the same antifungal treatment was continued but a surgical opinion was planned if no improvement was noted. Unfortunately, we lost of follow-up the patient.