Persistent Fever and Urinary Hyphae as Diagnostic Clues to Aspergillosis: A Case Report

Abstract

Invasive aspergillosis is an opportunistic fungal infection that is frequently underdiagnosed, especially in critically ill or immunocompromised patients. This case involves a 45-year-old woman with no relevant medical history who developed persistent fever, respiratory symptoms, and hemodynamic instability. Despite receiving multiple antibiotic regimens, no clinical improvement was observed. The detection of hyphae and conidia in the urinalysis during hospitalization directed the diagnostic approach toward deep aspergillosis—a rare but significant finding. The patient exhibited septic shock with urinary and pulmonary foci, acute type 1 respiratory failure, severe thrombocytopenia, hypokalemia, and bilateral pleural effusion. Broad-spectrum antifungal treatment and intensive supportive care were administered. This case underscores the need to consider fungal etiologies in patients with fever of unknown origin, particularly when atypical clinical and laboratory findings suggest an invasive mycotic infection.