key: cord-0849195-9t1dwo9u authors: Swain, Satish; Ray, Animesh; Sarda, Radhika; Vyas, Surabhi; Singh, Gagandeep; Jorwal, Pankaj; Kodan, Parul; Khanna, Puneet; Xess, Immaculata; Sinha, Sanjeev; Wig, Naveet; Trikha, Anjan title: COVID‐19‐associated subacute invasive pulmonary aspergillosis date: 2021-09-29 journal: Mycoses DOI: 10.1111/myc.13369 sha: 6e11d91684070a4ea57f7dd6d8437841cfa7edc1 doc_id: 849195 cord_uid: 9t1dwo9u BACKGROUND: Though invasive pulmonary aspergillosis is a well known complication of COVID‐19 pneumonia, indolent forms of aspergillosis have been rarely described. METHODS: We prospectively collected the clinico‐radio‐microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID‐19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp. RESULT: The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID‐19 illness with a mean duration of 29.2 ± 12 days from COVID‐19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post‐COVID‐19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow‐up period. CONCLUSION: SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID‐19 in the background of steroid use with or without pre‐existing diabetes. TA B L E 1 Clino-radio-microbiological profile and outcome of SAIA patient cohort and describe their clinico-radio-microbiological profile. We prospectively collected the data of all the patients, who were <300 mm Hg or lung infiltrates >50% were considered to have severe disease. 3 The diagnosis of SAIA was based on ERS and ESCMID 2016 guidelines for management of chronic pulmonary aspergillosis which also covered SAIA. 4 The patients were followed up till outcome (death or discharge) or four weeks from initial diagnosis of SAIA (whichever was earlier). A subsequent follow-up was done at end of 3 months from diagnosis of SAIA for all patients. with a cut-off >12 U/ml (for both). Ethics clearance for the study was taken from Institutional Ethical We present a cohort of patients with COVID-19-associated SAIA having recent diagnosis of COVID-19. Majority of the patients had diabetes and all had received steroids for their COVID-19 condition. All of them presented with cavitating lung disease, IgG Aspergillus positivity and most had Aspergillus spp isolated from their respiratory samples. The initial reports describing chronic necrotising pulmonary (CNPA) aspergillosis, date back to more than 50 years. 7 The first reference of SAIA, a term which is used interchangeably with CNPA, appears to have been made in 1983 by Gefter et al. 8 SAIA refers to the slowly progressive form of invasive aspergillosis, usually seen in mildly immunocompromised patients. 9 The disease usually progresses over 1-3 months and presents with variable radiological features like cavitation, nodules or consolidation. 10 In conclusion, SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID-19 in the background of steroid use with or without preexisting diabetes. Early diagnosis and prompt treatment can help in appropriate management of such cases. None. 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