Discussion
Since the new pneumonia was first recognized in Wuhan, China, at the end of 2019, the causative pathogen SARS-CoV-2 has been identified, and its associated infection, COVID-19, has rapidly evolved worldwide. While SARS-CoV-2 is responsible for severe pneumonia and ARDS, COVID-19 is associated with a wide variety of extrapulmonary complications; many other organs can be affected, including cardiovascular, immune, nervous, and gastrointestinal systems, therefore, can be considered a systemic disease. In addition to common bacteria and viruses, Aspergillus can cause co-infection in COVID-19 patients, especially in severe/critical illnesses. The possibility of co-infection with bacterial or fungal infections is higher in patients who require follow-up in intensive care units or require mechanical ventilation(4). Among the possible pathogens in COVID-19 patients, Invasive pulmonary aspergillosis  (IPA ) carries more attention to Aspergillus as it is challenging to diagnose and can be associated with high morbidity and mortality. In particular, respiratory samples for mycological studies such as fungal culture, galactomannan test, and PCR from respiratory tract samples can help early diagnosis. In our case, the culture results of the patient who was followed up and treated with the non-intubated high flow for five days in the intensive care unit during this period were typical.
All studies of COVID-19 fungal infections have reported that they occur during COVID-19 infection, mostly 14 days after the onset of COVID-19 symptoms(5). In this case, a cavitary lesion in the right upper lobe was observed in the fourth month of the patient’s COVID-19 treatment.
In COVID-19-associated pulmonary aspergillosis, diabetes, immunosuppressive drug use, steroid therapy, and intubating are risk factors for patients followed. It also increases the risk of pulmonary aspergillosis in COVID-19 patients using IL-6 antagonists (6). In our case, four vials of 162 mg tocilizumab were given on the 12th day of the patient’s treatment. The patient had fibrotic lesions on the thorax CT, and dyspnea continued. The patient was followed up under steroid and colchicine treatment for about four months after discharge, and a cavitary lesion in the right upper lobe was observed in the fourth-month tomography.
Aspergillosis is one of the most common opportunistic fungal co-infections caused by certain Aspergillus species, mainly affecting immunocompromised individuals such as COVID-19 patients. It can critically affect the respiratory system, leading to a mild/serious lung infection known as pulmonary aspergillosis, a severe form of aspergillosis that worsens over time and has no effective treatment.