Aspergillus fumigatus Bloodstream Infection in the Absence of Classic Risk Factors: Expanding the Spectrum of Invasive Aspergillosis

We report an unusual case of <i>Aspergillus fumigatus</i> fungemia in a 65-year-old male with multiple comorbidities including, human immunodeficiency virus (HIV), chronic obstructive pulmonary disease (COPD), diabetes mellitus, hepatitis C, and metastatic small cell lung cancer on chemotherapy. He presented with pneumonia and acute hypoxic respiratory failure requiring intubation. The patient developed septic shock and a peripherally inserted central catheter (PICC-line)-associated methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA) bacteremia treated with intravenous (IV) cefazolin. Blood cultures unexpectedly revealed <i>A. fumigatus</i> despite a lack of classic risk factors, other than advanced acquired immune deficiency syndrome (HIV/AIDS), such as prolonged neutropenia or stem cell transplantation. Suspected sources included disseminated infection from the lungs and/or the infected PICC line. This case highlights the diagnostic and therapeutic challenges of invasive aspergillosis, a rarely reported and poorly understood entity with a high mortality rate. Further studies are needed to better characterize the epidemiology, risk factors, and optimal management of <i>Aspergillus</i> fungemia in diverse immunocompromised populations.