Coexistence of pulmonary aspergillosis and cryptococcosis following treatment for SARS-CoV-2 infection in a kidney transplant recipient: a rare case report and literature review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)- associated pneumonia increases patients’ susceptibility to fungal superinfections, particularly among immunocompromised individuals. A 60-year-old woman with history of kidney transplantation was admitted for recurrent fever and positive SARS-CoV-2 antigen on pharyngeal swab testing. The patient developed rapid-onset respiratory distress secondary to progressive pulmonary infection and received assisted mechanical ventilation. Microbiological sequencing and culture of bronchoalveolar lavage fluid and sputum, as well as serological tests, revealed the presence of Aspergillus fumigatus, Aspergillus lentulus and Cryptococcus neoformans, along with multiple bacterial and viral pathogens. Following a course of combined antifungal, antibacterial, and antiviral therapies, the patient was successfully weaned off mechanical ventilation. The lung exudates and the large cavitary abscess were absorbed completely. We reported successful treatment of a rare case of concurrent aspergillosis and cryptococcosis following SARS-CoV-2 pneumonia in a kidney transplantation recipient. The severe fungal infection was probably attributed to the immunosuppressive status associated with a history of solid organ transplantation, as well as prolonged administration of glucocorticoid and antibiotics.