Cleaning air filtration induced invasive pulmonary aspergillosis: a case report

【摘要】：Background: The Aspergillus is known to predominantly affect the immunocompromised host, but it is rare to cause acute invasive pulmonary aspergillosis(IPA) in immunocompetent hosts which is invariably fatal. Here we report a case of acute IPA in an immunocompetent patient after cleaning air filtration with no underlying disease. This is the first case in the literature about cleaning air filtration induced pulmonary aspergillosis.Case presentation: An immunocompetent 41-year-old man presented with several days history of fever and productive cough with respiratory distress. These symptoms were unresponsive to treatments for pulmonary bacterial infection. He was exposed to air conditioning dust during cleaning air filtration. Computed tomography images revealed the characteristic tree-in-bud pattern along the bronchus and bronchiolitis associated with thickened bronchial walls. Later the galactomannan(GM) test in BALF was positive. So we performed empirical antifungal treatment with intravenous voriconazole 400 mg/d for 4 months. The patient recovered after antifungal therapy. Later microbiological examination of the BALF revealed growth of A. fumigatus hyphae.Conclusion :In cases of pulmonary dysfunction after cleaning air filtration, with tree-in-bud pattern along the bronchus and bronchiolitis associated with thickened bronchial walls on the CT, clinicians should consider aspergillus inhalation as an aetiology, and early antifungal therapy is recommended. And we should consider an occupational hazard for air conditioning sweeper.