CASE REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Extracorporeal Membrane Oxygenation Therapy for Severe Influenza-Associated Pulmonary Aspergillosis: A Case Report
Henan Provincial People's Hospital, Zhengzhou, China
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Abstract
Background: Influenza-associated invasive pulmonary aspergillosis (IAPA) is an increasingly recognized life-threatening condition in non-classically immunocompromised hosts. This report describes the clinical course and management of severe IAPA involving significant airway invasion. Case Description: A 34-year-old female presented with a one-week history of fever and rapidly progressive dyspnea. Laboratory testing confirmed influenza A (H1N1) infection and significantly elevated serum galactomannan (GM) index 5.436. Despite invasive mechanical ventilation, the patient developed refractory acute respiratory failure (ARF) characterized by extreme airway resistance(190 cmH2O/L/s) and extensive subcutaneous emphysema. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated as a bridge to facilitate diagnostic bronchoscopy, which revealed extensive necrotic pseudomembranes. Subsequent BALF microscopy and mNGS confirmed Aspergillus fumigatus coinfection with Influenza A (H1N1), establishing the diagnosis of IAPA. Management involved a combination of systemic and localized bronchoscopic antifungal therapy (Amphotericin B) and iterative airway clearance. Despite complications including secondary extensively drug-resistant Pseudomonas aeruginosa infection and suspected drug-induced hemolysis, the patient was successfully weaned from ECMO on March 22, 2023 and eventually discharged following clinical improvement. Conclusion: VV-ECMO combined with repeated bronchoscopic interventions can serve as a rescue strategy in selected patients with airway-invasive IAPA and refractory respiratory failure.
Summary
Keywords
Bronchoscopy, Critical Care, Extracorporeal Membrane Oxygenation, influenza, Invasive Pulmonary Aspergillosis
Received
26 October 2025
Accepted
09 February 2026
Copyright
© 2026 Tian, Liang, Zhang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xiaoju Zhang
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