PMC:7646269 / 8821-9915
Annnotations
Patient 2 was a 79‐year‐old man with a history of hypertension, coronary artery disease, transient ischaemic attack, and renal cell carcinoma who was transferred to the ICU on hospital day 6 for worsening acute hypoxemic respiratory failure requiring intubation and mechanical ventilation. He was afebrile and had been on non‐invasive ventilation (NIV) for 6 days before Aspergillus isolation on hospital day 7. Respiratory culture grew Aspergillus fumigatus and Staphylococcus aureus. A chest CT showed dense bilateral lower lobe consolidations, multifocal ground‐glass opacities, pneumomediastinum and pneumopericardium. He was initially treated with cefepime and vancomycin. Voriconazole was started at the second positive culture for Aspergillus. A repeat chest CT showed similar findings together with worsening ground‐glass opacities. Despite subsequent treatment with meropenem, vancomycin, and voriconazole, he continued to deteriorate with persistent leukocytosis, worsening respiratory status, and multiorgan dysfunction. He expired 13 days after the initiation of antifungal therapy.