From clarinet notes to critical care: dual antifungal therapy in an immunocompetent patient with a diagnosis of invasive pulmonary aspergilosis. Case report

Mercedes Carrasco-Sánchez, Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
Javier Carrillo-Hernández-Rubio, Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
Estefanía Llopis-Pastor, Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
Mercedes García-Salmones-Martín, Servicio de Neumología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain

Invasive pulmonary aspergillosis is a severe fungal infection, typically associated with immunocompromised patients. An atypical case of invasive pulmonary aspergillosis is presented in a 65-year-old immunocompetent patient, a smoker, and a clarinetist. Treatment involved the administration of intravenous antifungals (voriconazole and amphotericin B) and nebulized therapy (amphotericin B). Additionally, hypersensitivity pneumonitis related to continuous exposure to Aspergillus fumigatus during clarinet practice was identified. This case underscores the uniqueness of invasive pulmonary aspergillosis in non-immunocompromised patients and emphasises the necessity for therapeutic approaches tailored to exceptional clinical circumstances.

Keywords: Invasive pulmonary aspergillosis. Voriconazole. Amphotericin B. Hypersensitivity pneumonitis.