To report a case of invasive pulmonary aspergillosis due to Aspergillus lentulus in a pediatric patient with chronic granulomatous disease (CGD) and to highlight the importance of identifying the causative microorganism in the context of limited existing literature.
Key Findings:
Aspergillus lentulus was confirmed as the causative pathogen through blood mNGS, highlighting the need for advanced diagnostic methods.
A pathogenic mutation in the X-linked CYBB gene confirmed the diagnosis of chronic granulomatous disease, emphasizing the link between CGD and susceptibility to rare infections.
Combination therapy with voriconazole and micafungin led to clinical improvement, suggesting a potential treatment pathway for similar cases.
Interpretation:
This case highlights the rarity of Aspergillus lentulus infections in children and the challenges in treating such infections, particularly in immunocompromised patients, suggesting a need for further research.
Limitations:
No previous cases of Aspergillus lentulus infection in children with CGD have been reported, indicating a gap in the literature.
There is no consensus on the optimal antifungal regimen for pediatric Aspergillus lentulus infections, which may lead to variability in treatment approaches.
Conclusion:
The case underscores the importance of identifying the causative microorganism and the potential of mNGS in diagnosis, while also providing a reference for managing refractory fungal infections, advocating for its broader use in clinical settings.
A retrospective cohort study of more than 520,000 hospitalized patients found no clinically meaningful improvement in deterioration or mortality with early treatment targeting community-acquired pneumonia.
