Gardening can induce pulmonary failure: Aspergillus ARDS in an immunocompetent patient, a case report

BMC Infect Dis. 2014 Nov 26:14:600. doi: 10.1186/s12879-014-0600-6.

Abstract

Background: Acute Aspergillus fumigatus infection in immunocompetent patients is rare. This is the first known case of a patient who survived Aspergillus sepsis after being treated early with veno-venous extracorporeal membrane (ECMO) and antifungal therapy.

Case presentation: An immunocompetent 54-year-old woman was exposed to plant mulch during gardening and subsequently developed pulmonary failure that progressed to sepsis with multiorgan failure. Owing to her severe clinical condition, she was treated for acute respiratory distress syndrome (ARDS) with veno-venous ECMO. Empiric antifungal therapy comprising voriconazole was also initiated owing to her history and a previous case report of aspergillosis after plant mulch exposure, though there was no microbiological proof at the time. A. fumigatus was later cultured and detected on antibody testing. The patient recovered, and ECMO was discontinued 1 week later. After 7 days of antifungal treatment, Aspergillus antibodies were undetectable.

Conclusions: In cases of sepsis that occur after gardening, clinicians should consider Aspergillus inhalation as an aetiology, and early antimycotic therapy is recommended.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillus fumigatus / isolation & purification*
  • Extracorporeal Membrane Oxygenation / methods
  • Female
  • Gardening*
  • Humans
  • Immunocompetence
  • Middle Aged
  • Pulmonary Aspergillosis / complications
  • Pulmonary Aspergillosis / microbiology*
  • Pulmonary Aspergillosis / therapy
  • Respiratory Distress Syndrome / etiology*
  • Respiratory Distress Syndrome / therapy
  • Sepsis / complications
  • Sepsis / microbiology*
  • Sepsis / therapy

Substances

  • Antifungal Agents