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Introduction <p>Invasive aspergillosis is sparsely reported in patients with autoimmune diseases such as systemic lupus erythematosus, particularly in the Nigerian setting. Our case emphasizes the need to consider this seemingly rare presentation in immunocompromised Nigerian children.</p> Case Presentation <p>We report a known case of systemic lupus erythematosus with symptoms of high-grade continuous fever, progressive weight loss, generalized body weakness, and dull aching right hypochondrial pain of 2 months duration. No respiratory symptoms were present at presentation despite having an initial positive serum <i>Aspergillus</i> galactomannan titer of 9.6. She had persistent <i>Plasmodium falciparum</i> parasitemia and a full blood count showed neutrophilia. She was initially managed as a case of resistant malaria and sepsis with intravenous quinine and antibiotics, and subsequently discharged after resolution of symptoms. Three weeks later, she presented with worsening clinical signs of fever, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea, and cyanosis. Chest X-ray showed focal nodules, haziness and areas of infiltration. A repeat assay of serum <i>Aspergillus</i> galactomannan level showed a markedly elevated titre of 21.5. A diagnosis of invasive pulmonary aspergillosis in an active systemic lupus erythematosus was made, and she was commenced on oral itraconazole and discharged after clinical resolution of presenting symptoms within a week of treatment. However, she again presented a week later with severe orthopnea, chest pains, delirious and tachypneic with tender hepatomegaly, and eventual demise within 6&#xa0;h of presentation.</p> Conclusions <p>Where an early laboratory evidence is available, we recommend initiating antifungal prophylaxis in patients with systemic lupus erythematosus flares regardless of the absence of symptoms suggesting an invasive fungal disease.</p>

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Invasive Pulmonary Aspergillosis in a Nigerian Child with Systemic Lupus Erythematosus: a Case Report

  • 期刊论文

  • 发表日期：

    2025年11月29日

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  • Ekaete Brown,
  • Bassey Ekeng,
  • Ikechukwu Agwu,
  • Christian Ide,
  • Olufunke Adedokun,
  • Usenobong Akpan,
  • Charity Ajake,
  • Bernard Monjol,
  • Ubokobong Eshiet

摘要

Introduction

Invasive aspergillosis is sparsely reported in patients with autoimmune diseases such as systemic lupus erythematosus, particularly in the Nigerian setting. Our case emphasizes the need to consider this seemingly rare presentation in immunocompromised Nigerian children.

Case Presentation

We report a known case of systemic lupus erythematosus with symptoms of high-grade continuous fever, progressive weight loss, generalized body weakness, and dull aching right hypochondrial pain of 2 months duration. No respiratory symptoms were present at presentation despite having an initial positive serum Aspergillus galactomannan titer of 9.6. She had persistent Plasmodium falciparum parasitemia and a full blood count showed neutrophilia. She was initially managed as a case of resistant malaria and sepsis with intravenous quinine and antibiotics, and subsequently discharged after resolution of symptoms. Three weeks later, she presented with worsening clinical signs of fever, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea, and cyanosis. Chest X-ray showed focal nodules, haziness and areas of infiltration. A repeat assay of serum Aspergillus galactomannan level showed a markedly elevated titre of 21.5. A diagnosis of invasive pulmonary aspergillosis in an active systemic lupus erythematosus was made, and she was commenced on oral itraconazole and discharged after clinical resolution of presenting symptoms within a week of treatment. However, she again presented a week later with severe orthopnea, chest pains, delirious and tachypneic with tender hepatomegaly, and eventual demise within 6 h of presentation.

Conclusions

Where an early laboratory evidence is available, we recommend initiating antifungal prophylaxis in patients with systemic lupus erythematosus flares regardless of the absence of symptoms suggesting an invasive fungal disease.