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

Nina Jung, Silke Mronga, Susanne Schroth, Timon Vassiliou, Frank Sommer, Eduard Walthers, Christian Aepinus, Andreas Jerrentrup, Claus Vogelmeier, Angelique Holland, Rembert Koczulla

BackgroundAcute 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 presentationAn 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.ConclusionsIn cases of sepsis that occur after gardening, clinicians should consider Aspergillus inhalation as an aetiology, and early antimycotic therapy is recommended.