A Case of Aspergillosis Battling Thrombosis: Challenging Diagnosis and Treatment in an Immunocompetent Patient

Invasive pulmonary aspergillosis (IPA) is typically seen in immunocompromised patients, but may also develop in immunocompetent individuals, and is associated with high mortality rates.We report here on the case of a 47-year-old male patiet with a history of asthma who presented with fever, cough and sputum production.He was initially diagnosed with hospitalacquired pneumonia and started on appropriate treatment, however, his symptoms persisted.Further investigations revealed Aspergillus spp., leading to a diagnosis of invasive aspergillosis.Radiological imaging revealed a lesion in the left upper lobe, and the diagnosis was confirmed through transthoracic needle biopsy.The patient was started on intravenous voriconazole, but developed thrombosis in the right cephalic vein.Anticoagulation therapy with enoxaparin was added to the protocol, however, balancing the treatment of thrombosis with the risk of bleeding presented a challenge.This case highlights the challenges that can be encountered in clinical diagnosis and treatment, and shows that aspergillosis should be considered even in immunocompetent patients.It further clarifies the need to find the optimum balance between thrombosis treatment and bleeding risk, as a critical aspect of the treatment process in cases of invasive aspergillosis.