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COVID-19 PNEUMONIA WITH SYNCHRONOUS ASPERGILLOSIS LEADING TO PARENCHYMAL LUNG RUPTURE
A Isaacson, D Springstead
Wayne State University

Background
The SARS-CoV 2 (COVID-19) global pandemic of 2020 has presented a multitude of new and unforeseen complications across all fields of medicine. Widely known are the pulmonary complications and flu-like syndrome accompanying infection. We present a report of a patient that had a synchronous Aspergillus infection during his COVID-19 infection, resulting in a pneumothorax and massive subcutaneous emphysema.

Methods
A 55-year-old male presented in respiratory distress to our emergency department. He was in a nursing home recovering from COVID Pneumonia and Aspergillosis. On chest x-ray, he was found to have a large pneumothorax and subcutaneous emphysema. A 14-French pneumothorax catheter was placed. The patient had some decrease in symptoms and increase in lung volumes on x-ray; Cross-sectional imaging revealed the patient still had a large pneumothorax. Evaluation of the pleurevac system revealed an expiratory air leak. On hospital day 3, the patient had an increase in oxygen requirement and went into severe respiratory distress. At this time, he had a continuous air leak and increasing subcutaneous emphysema. Given the clinical picture, the patient was taken to OR for thoracic exploration and possible wedge resection.

Results
The patient was taken to the OR for a right sided VATS procedure, which was converted to a thoracotomy upon recognition of necrotic right upper lobe. The patients previously known aspergillosis ball was found to be necrotic and spontaneously ruptured. A non-anatomic right upper lobe resection was performed inclusive of the lesion. The entirety of the lung parenchyma was noted to be very stiff and had significant fibrosis, consistent with a history of COVID. The patient tolerated the procedure well, extubated 48 hours later and discharged on post-operative day 16 to inpatient rehabilitation. He was seen in clinic during and after rehabilitation was complete and is doing well, being slowly weaned from his home oxygen supplementation

Conclusion
The COVID-19 virus has caused a global loss of life in the millions. The presence of this virus and its long-term effects are still being elicited. The effects on the immune system that led this otherwise healthy male to develop aspergillosis, and subsequently a massive parenchymal airleak, remain a mystery.


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