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Reminder of important clinical lesson
CASE REPORT
Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula
  1. Christiana Page1,
  2. Laura Blazy2,
  3. Melanie Jenkins3,
  4. Rosalba Spiritoso1
  1. 1Department of Intensive Care, Barts Health NHS Trust, St Bartholomew’s Hospital, London, UK
  2. 2Department of Intensive Care, Saint George’s Hospital, London, UK
  3. 3Department of Thoracic Surgery, Saint George’s Healthcare NHS Trust, St George’s Hospital, London, UK
  1. Correspondence to Dr Laura Blazy, Laura.blazy{at}nhs.net

Summary

A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.

Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation. This case demonstrates an atypical presentation of invasive pulmonary aspergillosis in a mildly immunodeficient individual. It highlights the challenges in assessment and management of critically ill patients’ nutrition as well as optimal timing for surgical intervention.

  • Tb And other respiratory infections
  • mechanical ventilation
  • malnutrition
  • parenteral / enteral feeding
  • cardiothoracic surgery

https://doi.org/10.1136/bcr-2017-222143

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    Footnotes

    • Contributors CP, LB and RS contributed to the conception and design of this case report. CP and LB involved in writing of original draft. CP, LB, MJ and RS contributed to interpretation of data, critical revision and final approval of the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained from next of kin.

    • Provenance and peer review Not commissioned; externally peer reviewed.