Invasive pulmonary aspergillosis in HIV patient with high CD4 count

Background: Severe immunosuppression remains the major risk factor for acquiring invasive aspergillosis. Invasive pulmonary aspergillosis (IPA) occurs uncommonly among HIV patients, mostly in those with neutropenia or CD4 count less than 50 cells/uL and has a very high mortality above 70% even with
treatment.
Case Report: We report a case of probable invasive pulmonary aspergillosis in a non-neutropenic HIV patient with a high CD4 count of 863 cells/uL who is HIV treatment naïve and has no history of AIDS defi ning illness. Using the EORTC/MSG (European Organization for Research and Treatment of Cancer/ Mycoses Study Group) criteria, diagnosis was made following presentation with fever, cough, dyspnea, hemoptysis, suggestive CT, a positive culture for Aspergillus fumigatus, and positive serum aspergillus galactomannan assay. Patient responded to antifungal therapy.
Conclusions: This case emphasizes the need to seriously consider invasive pulmonary aspergillosis in patients who are non-neutropenic, HIV infected with high CD4 count who present with respiratory symptoms as in the described case and lack response to standard antimicrobial therapy.

Keywords: ASPERGILLOMA, Immunosuppression, invasive aspergillosis, HIV/AIDS