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.