Embolizing pulmonary aspergillosis, mycobacterial & aspergillous splenic abscess and cytomegalovirus co-infection following steroid induced immunosuppression: a case report

Abstract

BackgroundAspergillosis is a serious infection particularly affecting the immunodeficient host. Its co-infection with tuberculosis and cytomegalovirus has not been reported before. Embolic events are well recognized with aspergillous endocarditis and aortitis. Splenic abscess is a rare serious complication of disseminated aspergillosis and is difficult to treat. We report the first case of multiple embolic events and splenic abscess in a patient with pulmonary aspergillosis and cytomegaloviral and tuberculous co-infection, without endocarditis or aortitis.Case presentationThirty-year-old male presented with fever and non-productive cough while on glucocorticoids for glomerulonephritis. He was found to have pulmonary aspergillosis and subsequently developed bilateral lower limb and cerebral fungal emboli and fungal abscess in the spleen. He had IgM and B cell deficiency and cytomegalovirus (CMV) and tuberculous co-infections. He recovered after prolonged course of antimicrobials, splenectomy and cessation of glucocorticoid therapy which also lead to the resolution of immune deficiencies.ConclusionThis report illustrates rare combination of B and T cell suppressive effects of glucocorticoids leading to co-infections with CMV, Mycobacterium tuberculosis and Aspergillus and systemic fungal embolization from pulmonary aspergillosis.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3293-4) contains supplementary material, which is available to authorized users.

Triple infection with disseminated tuberculosis, invasive aspergillosis and COVID-19 in an organ transplant recipient with iatrogenic immunosuppression

“… 2 Impairment of neutrophilic action and structural lung defects including granulomas caused by tuberculosis thereby increase the risk of aspergillosis. 3 Due to this correlation, coinfections with tuberculosis and aspergillosis have been described before. 3 …”

“… 3 Due to this correlation, coinfections with tuberculosis and aspergillosis have been described before. 3 …”

“…2 Impairment of neutrophilic action and structural lung defects including granulomas caused by tuberculosis thereby increase the risk of aspergillosis. 3 Due to this correlation, coinfections with tuberculosis and aspergillosis have been described before. 3 Interestingly, coinfections of tuberculosis and COVID-19 19 have also been described, [4][5][6] and in fact, an observational study has concluded that tuberculosis increases the susceptibility to COVID-19.…”

“…3 Due to this correlation, coinfections with tuberculosis and aspergillosis have been described before. 3 Interestingly, coinfections of tuberculosis and COVID-19 19 have also been described, [4][5][6] and in fact, an observational study has concluded that tuberculosis increases the susceptibility to COVID-19. 7 A meta-analysis however showed no increase in susceptibility but concluded that patients with pre-existing tuberculosis are more likely to develop serious complications from COVID-19.…”

"Late Infectious Complications in Solid Organ Transplant: Disseminated Aspergillosis and Pulmonary Tuberculosis in a Patient with Kidney Transplant"

“…Infections remain one of the main complications after kidney transplantation, along with cardiovascular and neoplasic disease [1][2][3][4]. Anti-rejection immunosuppressive management composed of a calcineurin inhibitor, antimetabolite and steroid interfere with the normal function of neutrophils and immune responses mediated by T and B cells, increasing the risk of viral, fungal and bacterial infections in the patient with kidney transplant [2,5].…”