Ultra-early Invasive Pulmonary Aspergillosis after Mild Influenza A

Abstract

Influenza-associated invasive pulmonary aspergillosis (IAPA) is a rare complication, usually affecting critically ill or immunocompromised patients. The case of a patient who first presented on January 2, 2025, with fever, productive cough, and pleuritic chest pain is presented. Imaging showed non-specific viral pneumonia without typical fungal features. Diagnosis was confirmed by positive sputum culture for Aspergillus fumigatus, two consecutive elevated serum galactomannan levels, positive fungal nucleic acid testing, and high-load Aspergillus reads on bronchoalveolar lavage fluid targeted next-generation sequencing. The patient received Voriconazole for 7.5 weeks with marked clinical and radiological improvement. Follow-up six weeks after discontinuation showed no recurrence. This case highlights the fact that IAPA may occur early in immunocompetent adults with mild influenza. High clinical suspicion and multimodal diagnostic testing are essential for timely recognition.

Keywords: Post-influenza complications, Rapid diagnosis, Public health.