Unmasking Invasive Pulmonary Aspergillosis: Insights From a Case Series at a Tertiary Care Center

Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection that primarily affects individuals with significant immunosuppression, including those receiving treatment for hematological malignancies or undergoing solid organ or hematopoietic stem cell transplantation. Additional risk factors include severe or prolonged viral infections such as influenza and COVID-19 requiring intensive care, as well as underlying conditions such as diabetes mellitus and chronic granulomatous disease. Although the clinical course could be variable, the initial presentation is often ill-defined. All three patients in this case series presented with fever and productive cough, and one developed hemoptysis during the ward stay. Diagnosis was established using a combination of radiological imaging, bronchoscopy with bronchoalveolar lavage for fungal cultures, and galactomannan antigen testing. Radiological findings were diverse, ranging from tree-in-bud nodules and cavitating consolidations to the rare occurrence of hydropneumothorax. Despite the importance of early recognition and prompt antifungal therapy, diagnosis and management remain challenging. This case series highlights the heterogeneous manifestations of invasive pulmonary aspergillosis, the diagnostic and therapeutic difficulties encountered, and the complexities of antifungal selection in the presence of organ dysfunction. Early detection and a multidisciplinary approach are essential for improving clinical outcomes. In situations where microbiological confirmation is not feasible, a high degree of clinical suspicion, characteristic radiological findings, and a favorable clinical response to empirical antifungal therapy may improve clinical outcomes.