What question did this study set out to answer?

To describe the clinical management of Aspergillus empyema in a 67-year-old immunocompromised female patient.

May 20, 2026

A47-23 Aspergillus Empyema in an Immunocompromised Host

Key Points

To describe the clinical management of Aspergillus empyema in a 67-year-old immunocompromised female patient.
Presented a detailed case study of a 67-year-old female with multiple previous cancers and immunocompromised status.
Utilized a chest tube for empyema drainage, administered voriconazole and micafungin for fungal infection management.
Monitored the patient post-intubation with plans for steroid tapering and continuation of antifungal therapy.
Successful extubation 5 days post-intubation on nasal cannula.
Patient maintained on voriconazole and chest tube for ongoing air leak management.
Utilized both medical and surgical strategies to address complications stemming from Aspergillus empyema.

Abstract

Abstract Introduction Empyema secondary to the Aspergillus is a rare finding usually seen in the immunocompromised population. We present a case of Aspergillus empyema in an immunocompromised host. Case Presentation This case is about a 67-year-old female with a prior history of Rheumatoid Arthritis on methotrexate, remote breast cancer status post left mastectomy with chemotherapy and radiation (2004), and stage IIA Squamous Cell Carcinoma of the left upper lobe status post open lobectomy complicated by persistent pneumothorax found to have recurrent lung cancer status post 4 cycles of docetaxel + cisplatin now on pembrolizumab who initially presented with altered mental status.She had weeks of confusion leading up to a fall and ED presentation, where she was found to have a large left hydropneumothorax and hypoxia. She was given vancomycin, piperacillin-tazobactam, and methylprednisolone. Infectious Disease, Thoracic Surgery, and Pulmonology were consulted. Recent outpatient bronchoalveolar lavage had demonstrated Aspergillus fumigatus growth; voriconazole was started and left-sided chest tube was placed for empyema. Due to imaging concern for worsened checkpoint-induced pneumonitis, she was also started on daily prednisone. Her respiratory status worsened to the point of intubation, prompting synergistic treatment of Aspergillus with micafungin and management of pneumonitis with IVIG. She was extubated to nasal cannula 5 days later with plans for steroid taper and potential lifelong voriconazole while maintaining a chest tube at home for continued air leak in the setting of suspected bronchopleural fistula. Discussion Management of aspergillus empyema often includes pleural drainage if feasible and necessary to maintain source control. Causes may include recent thoracic surgeries, immunocompromised hosts, and ruptured aspergilloma, among other etiologies. There have been case reports describing use of chest tubes, surgical chest tubes, and video-assisted thoracoscopic surgery (VATS), and Clagett Windows to manage the pleural space in an Aspergillus empyema. In our patient’s case, chest tube was left as a prolonged measure of source control with possible outpatient thoracic surgical procedure. Antimicrobials, notably voriconazole as in our patient, have been exemplary therapies if tolerated. This abstract is funded by: None

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