Invasive Aspergillosis Following Dengue: An Autopsy Case and Review of the Literature.
Avichal Rajpal, Immanuvel Jebaraj, Inderpaul Singh Sehgal et al.
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Case in brief
A previously healthy 25-year-old woman presented with fever and multiorgan dysfunction; dengue IgM was positive, and other tropical infections were excluded. She developed progressive respiratory failure, refractory shock, and acute kidney injury despite intensive care and died. Autopsy showed diffuse alveolar damage and extensive invasive aspergillosis involving the bronchi, pulmonary vasculature, and myocardium. The accompanying review identified 21 additional cases of invasive aspergillosis following dengue (total n = 22); overall mortality was 63.6%, and 23% of cases were diagnosed postmortem.
What made this case unusual
Autopsy demonstrated extensive invasive aspergillosis across the bronchi, pulmonary vasculature, and myocardium in a previously healthy patient with severe dengue.
Diagnostic / clinical pearl
In severe dengue with progressive respiratory failure or multiorgan dysfunction, invasive aspergillosis may complicate the illness and can be diagnosed only postmortem.
Why it matters
This case and review broaden the recognized spectrum of viral-associated aspergillosis to include severe dengue.