Unmasking the Hidden Threat: Invasive Pulmonary Aspergillosis Following Dengue Hemorrhagic Fever in an Immunocompetent Patient

Dengue hemorrhagic fever (DHF), an arbovirus-borne infection, is endemic in multiple regions across the globe. It has been observed that patients with severe viral respiratory tract infections are highly susceptible to developing a fungal co-infection. We present a similar case of a 27-year-old female diagnosed with DHF, reporting the development of aspergillosis during recovery from dengue fever. The patient presented with persistent high-grade fever, vomiting, hypotension, and body aches. Lab results showed a dropping platelet count and raised inflammatory markers. Dengue serology by enzyme-linked immunosorbent assay (ELISA) was positive. She had on-and-off episodes of shivering for which a malarial parasite smear was ordered, which came back negative. Chest X-ray showed a heterogeneous opacity in the right lower lobe. The patient was started on intravenous (IV) antibiotics (tazobactam + piperacillin and amikacin sulphate) along with IV dexamethasone. Chest physiotherapy and regular nebulization were also done. A bronchoscopy was performed, which was turbid. No acid-fast bacilli were found, but budding yeast cells were identified. The patient was put on voriconazole oral tablet, after which she became afebrile, and her oxygen saturation started stabilizing. There was a significant improvement in lab results and radiological investigations as well. She was discharged after a month of initial presentation, with antifungal medication until the next follow-up. There should be better means of investigation for such apparent serological disturbances, not dependent on invasive tests. Some modalities should be developed that are rapid, specific, and cost-effective.