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  • Title: Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula.
    Author: Page C, Blazy L, Jenkins M, Spiritoso R.
    Journal: BMJ Case Rep; 2018 Jan 17; 2018():. PubMed ID: 29348280.
    Abstract:
    A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation. This case demonstrates an atypical presentation of invasive pulmonary aspergillosis in a mildly immunodeficient individual. It highlights the challenges in assessment and management of critically ill patients' nutrition as well as optimal timing for surgical intervention.
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