Severe Fever with Thrombocytopenia Syndrome Accompanied by Invasive Pulmonary Aspergillosis: An Autopsy Case

• Main Authors: Kosho Iwao, Takeshi Kawaguchi, Masatoshi Kimura, Chihiro Iwao, Mao Rikitake, Ayako Aizawa, Yumi Kariya, Motohiro Matsuda, Syunichi Miyauchi, Ichiro Takajo, Takumi Kiwaki, Tsuyoshi Fukushima, Hiroaki Kataoka, Tadaki Suzuki, Akihiko Okayama, Kunihiko Umekita
• Format: Article
• Language: English
• Published: MDPI AG 2021-06-01
• Series: Viruses
• Subjects: severe fever with thrombocytopenia syndrome; invasive pulmonary aspergillosis; autopsy
• Online Access: https://www.mdpi.com/1999-4915/13/6/1086

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease in China, Korea, and Japan caused by the SFTS virus (SFTSV). SFTS has a high mortality rate due to multiorgan failure. Recently, there are several reports on SFTS patients with mycosis. Here, we report a middle-aged Japanese SFTS patient with invasive pulmonary aspergillosis (IPA) revealed by an autopsy. A 61-year-old man with hypertension working in forestry was bitten by a tick and developed fever, diarrhea, and anorexia in 2 days. On day 4, consciousness disorder was appearing, and the patient was transferred to the University of Miyazaki Hospital. A blood test showed leukocytopenia, thrombocytopenia, as well as elevated levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. The SFTSV gene was detected in serum using a reverse-transcription polymerase chain reaction. On day 5, respiratory failure appeared and progressed rapidly, and on day 7, the patient died. An autopsy was performed that revealed hemophagocytosis in the bone marrow and bleeding of several organs. IPA was observed in lung specimens. SFTSV infection may be a risk factor for developing IPA. Early diagnosis and treatment of IPA may be important in patients with SFTS.