Invasive Pulmonary Aspergillosis in a Previously Healthy Child With Primary Epstein–Barr Virus Infection

Invasive pulmonary aspergillosis (IPA) rarely occurs in previously healthy children. We report a case of IPA complicating primary Epstein–Barr virus (EBV) infection in a previously healthy 5-year-old Japanese boy. During acute EBV infection, he developed persistent fever, systemic inflammation, as reflected by elevated serum LDH (lactate dehydrogenase) and ferritin levels, and profound neutropenia (absolute neutrophil count <100/µL for >10 d), and received systemic corticosteroids. Persistent fever prompted further evaluation, and chest computed tomography showed multiple bilateral pulmonary nodules with halo signs. Positive serum galactomannan antigen supported a clinical diagnosis of IPA. Voriconazole therapy led to clinical and radiologic resolution. Comprehensive immunologic evaluation revealed no evidence of primary immunodeficiency. This case suggests that primary EBV infection, particularly when complicated by severe neutropenia and corticosteroid exposure, may cause transient immunosuppression sufficient to predispose otherwise healthy children to IPA. Early recognition and prompt antifungal treatment may improve outcomes.