Invasive Pulmonary Aspergillosis Due to Aspergillus Lentulus in a Liver Transplant Recipient: a Case Report and Literature Review

Background: Aspergillus lentulus, a new species discovered in 2005, is a rare fungal pathogen with reduced sensitivity to antifungal agents. Case presentation: Here we reported a 58-year-old male who underwent a liver transplantation on January 2020 and followed by maintenance immunosuppressive therapy. Then A.lentulus was cultured from his sputum twice and identified by using the MALDI-TOF-MS and confirmed by the reference of RUO database. In the susceptibility tests of the isolate, minimal inhibitory concentrations for amphotericin B, voriconazole, posaconazole, and caspofungin were found to be 0.5 mg/L, 1.0 mg/L, 0.5 mg/L and 8 mg/L, respectively. The patient was improved after treatment with a voriconazole 0.2g q12h orally plus caspofungin 50mg qd intravenously. Conclusion: A. lentulus is easily confused with A. fumigatus and its susceptibility to amphotericin B and azoles antifungal agents is reduced. Therefore, the identification of strain and drug susceptibility test are very important for clinical treatment.

Aspergillus lentulus: An Under-recognized Cause of Antifungal Drug-Resistant Aspergillosis

Aspergillus lentulus is a drug-resistant species that is phenotypically similar to A. fumigatus. It was discovered as a cause of azole-breakthrough disease, consistent with in vitro resistance. Clinical labs can misidentify the species as fumigatus based on phenotypic typing. We describe 4 recent cases and provide a brief review.