A 64-Year-Old Man Hospitalized for COVID-19 Pneumonia and Treated With Tocilizumab Who Developed Chronic Cavitary Pulmonary Aspergillosis

Authors

Adebola Oluwabusayo Adetiloye, Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York City, NY, USA.
Farhana Alladin, Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York City, NY, USA.
Rasha Alaameri, Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York City, NY, USA.
Julio C. Valencia-Manrique, Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York City, NY, USA.
Olurotimi Badero, Division of Cardio-Nephrology, Cardiac Renal & Vascular Associates, Jackson, USA.
Armeen Poor, Department of Pulmonary and Critical Care, New York Medical College, Metropolitan Hospital Center, New York City, NY, USA.

Author Type(s)

Resident/Fellow, Faculty

Journal Title

The American Journal of Case Reports

First Page

e938359

Document Type

Article

Publication Date

3-16-2023

Department

Medicine

Abstract

BACKGROUND The management of (Coronavirus disease 2019) COVID-19 pneumonia is ever-evolving. Tocilizumab, a monoclonal antibody against interleukin-6 (IL-6) receptor, have known mortality benefit in severe COVID-19 pneumonia, but data are limited regarding safety. Attributable to the immunomodulatory nature of this medication, patients may be at risk for opportunistic infections, including chronic cavitary pulmonary aspergillosis (CPPA), a slowly progressive disease characterized pulmonary infiltrates and often a newly-formed cavity. However, current guidelines do not emphasize post-treatment surveillance of patients for opportunistic infections, including CPPA. CASE REPORT We present a particular case of a 64-year-old man treated for COVID-19 pneumonia with Tocilizumab and dexamethasone who developed cavitary pulmonary aspergillosis. He presented to the emergency department with hemoptysis, associated with worsening productive cough, shortness of breath, and weight loss. Computed tomography (CT) of the chest showed areas of focal consolidation and a cavitary lung lesion within the left upper lobe. Sputum culture was positive for Aspergillus niger. The patient received a long course of oral triazole therapy for CPPA, with clinical improvement. CT scan of the chest at 9 months showed that the Itraconazole therapy was effective in resolving the extensive airspace disease and decreasing the size of the upper-lobe cavity and fungal ball. CONCLUSIONS This article illustrates the possibility of a serious infection such as CCPA as an adverse effect of Tocilizumab treatment, especially with concurrent immunosuppressive therapy. Furthermore, this case highlights the importance of regular monitoring of patients who have received Tocilizumab therapy to ensure that early signs of opportunistic infections such as CPPA are detected and treated promptly to prevent permanent lung damage.

Recommended Citation

Adetiloye, A. O., Alladin, F., Alaameri, R., Valencia-Manrique, J. C., Badero, O., & Poor, A. (2023). A 64-Year-Old Man Hospitalized for COVID-19 Pneumonia and Treated With Tocilizumab Who Developed Chronic Cavitary Pulmonary Aspergillosis. The American Journal of Case Reports, 24, e938359. https://doi.org/10.12659/AJCR.938359