Subacute invasive pulmonary aspergillosis in a patient with Papillon Lefevre Syndrome

Abstract

Pulmonary aspergillosis is an infectious disease whose clinical presentation often includes respiratory symptoms, although these are frequently nonspecific. It is highly associated with immunocompromised patients, such as those undergoing chemotherapy, recipients of allogeneic transplants, individuals on prolonged corticosteroid therapy, or those with immunodeficiency syndromes or severe neutropenia. Therefore, clinical suspicion should be considered within the context of opportunistic infections.  The invasive form of the disease is significantly more aggressive than other variants, such as allergic bronchopulmonary aspergillosis or aspergilloma. Among the clinical presentations, subacute invasive pulmonary aspergillosis stands out as one of the most severe. Early diagnosis, based on host criteria and histopathological evidence of the fungus, allows timely initiation of antifungal therapy, which is essential to improve prognosis. The diagnostic gold standard for invasive aspergillosis is the visualization of hyphae or a positive culture for Aspergillus spp. in affected tissue. However, due to the difficulty in obtaining biopsies, non-invasive tests such as serum or bronchoalveolar lavage (BAL) galactomannan and PCR in BAL are recommended, especially in immunocompromised patients. This report describes the case of a patient admitted to the Internal Medicine Ward of the Hospital del Niño Dr. José Renán Esquivel, in the Republic of Panama, between February and June 2024.