We report the case of a patient who developed invasive pulmonary aspergillosis (IPA) after corticosteroid therapy for coronavirus disease 2019 (COVID-19) complicated with acute respiratory distress syndrome (ARDS). A 78-year-old immunocompetent Japanese woman was admitted to our hospital due to fever and severe respiratory distress. Computed tomography (CT) scan on admission revealed multilobar ground-glass opacities in the lung periphery, and the polymerase chain reaction test was positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); thus, the diagnosis of COVID-19 was made. Given that her rapidly progressive respiratory failure met the ARDS criteria, she received methylprednisolone pulse therapy. Her condition gradually improved. However, on day 36 of admission, when the dose of corticosteroids was tapering, she developed a fever. CT scan revealed multiple new pulmonary cavitary nodules. Her serum Aspergillus antigen test was positive on admission, the pulmonary cavitary nodules had appeared with the recent fever, and serum β-D-glucan levels were elevated (58 pg/mL) during the course of treatment. Thus, the patient was diagnosed with IPA. Treatment with voriconazole was successful, and the nodular shadows had disappeared 6 months later.
As the complication of IPA with severe COVID-19 may worsen clinical outcomes, it is important to check serum Aspergillus antigens and β-D-glucan levels for early diagnosis of IPA in patients with severe COVID-19.