INVASIVE PULMONARY ASPERGILLOSIS AFTER CORTICOSTEROID THERAPY IN COVID 19

Öz

Although corticosteroids are widely used in COVID-19 treatment protocols, they are discussed in terms of opportunistic infections and invasive pulmonary aspergillosis due to immune suppression. This study was conducted to present a case of invasive pulmonary aspergillosis associated with high-dose corticosteroid therapy in two cases diagnosed with COVID-19. Both cases included in this study were young male patients who had no previous risk factor for invasive pulmonary aspergillosis, were diagnosed with hypertension, and did not have any addictions. Both cases received high-dose methylprednisolone treatment during the treatment of COVID-19 and invasive pulmonary aspergillosis infection developed in the post-covid period. One of the cases was accepted as exitus as a result of unresponsive cardiopulmonary resuscitation following the arrest that developed on the 81st day of the COVID-19 diagnosis and the 26th day of the IPA diagnosis, while the other was discharged with oxygen support on the 58th day of the COVID-19 diagnosis and the 19th day of the IPA diagnosis. IPA should be considered as a life-threatening complication in patients diagnosed with COVID-19 and receiving immunosuppressive therapy. If long-term and high-dose corticosteroids are used in COVID-19 patients, it may be indicated to be careful in terms of IPA and to screen these patients for this purpose.

Anahtar Kelimeler

• COVID-19
• Invasive pulmonary aspergillosis
• Corticosteroids

COVID-19’da Kortikosteroid Tedavi Sonrası Gelişen İnvazif Pulmoner Aspergilloz

Öz

COVID-19 tedavi protokollerinde kortikosteroidler yaygın olarak kullanılmasına rağmen bağışıklığın baskılaması nedeniyle fırsatçı enfeksiyonlar ve invaziv pulmoner aspergillozis yönünden tartışılmaktadır. Bu çalışma COVID-19 tanısı almış iki olguda yüksek doz kortikosteroid tedavisi ile ilişkili invaziv pulmoner aspergillozis olgusunu sunmak amacıyla yapılmıştır. Bu çalışmada yer alan her iki olgu daha önce invaziv pulmoner aspergillozis yönünden risk faktörü olmayan, hipertansiyon tanısı almış ve herhangi bir bağımlılıkları bulunmayan genç erkek hastalardır. Her iki olguda COVID-19 tedavisi süreçlerinde yüksek doz metilprednizolon tedavisi almış ve post-covid dönemde invaziv pulmoner aspergillozis enfeksiyonu gelişmiştir. Vakaların biri COVID-19 tanısın 81. ve IPA tanısının 26. gününde gelişen arrestin ardından yanıtsız kardiyopulmoner resustasyon sonucunda exitus kabul edilirken, diğeri COVID-19 tanısının 58. ve IPA tanısının 19. gününde oksijen desteği ile taburcu edilmiştir. IPA COVID-19 tanılı ve immünosupresif tedavi gören hastalarda yaşamı tehdit eden bir komplikasyon olarak düşünülmelidir. COVID-19 hastalarına uzun süreli ve yüksek doz kortikosteroid kullanılması halinde IPA yönünden dikkatli olunması ve bu hastaların bu amaçla taranması endike olabilir.

Anahtar Kelimeler

• COVID-19
• Invazif Pulmoner Aspergilloz
• Kortikosteroid tedavi

Kaynakça

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