Fatal invasive pulmonary aspergillosis caused by Aspergillus texensis: first documented human infection

Abstract Background Invasive Aspergillosis (IA) is a life-threatening infection in immunocompromised patients. Although Aspergillus fumigatus predominates, rare and cryptic species are increasingly recognized due to advances in molecular diagnostics. Case Presentation: We report a fatal case of invasive pulmonary aspergillosis caused by Aspergillus texensis in a 39-year-old woman with classical Hodgkin lymphoma complicated by hemophagocytic lymphohistiocytosis (HLH). She developed persistent fever, pancytopenia, progressive respiratory failure, and septic shock despite broad-spectrum antibacterial therapy. Bronchoalveolar lavage (BAL) microscopy demonstrated septate hyaline hyphae. Culture yielded yellow-green colonies, and calmodulin sequencing showed > 99% identity with A. texensis (GenBank: PX734618). Antifungal susceptibility testing (CLSI M38-A3) revealed elevated MICs for amphotericin B (16 µg/mL) and itraconazole (8 µg/mL), intrinsic resistance to fluconazole, and lower MICs for voriconazole, posaconazole, and isavuconazole. Despite antifungal therapy, the patient died of multiorgan failure. Conclusion This appears to be the first documented human infection due to A. texensis . The case highlights the expanding spectrum of pathogenic Aspergillus species and underscores the importance of molecular identification and antifungal susceptibility testing in high-risk patients.