Metagenomic Next-Generation Sequencing Assists in the Diagnosis of Mediastinal Aspergillus fumigatus Abscess in an Immunocompetent Patient: A Case Report and Literature Review

Infect Drug Resist. 2023 Mar 30:16:1865-1874. doi: 10.2147/IDR.S399484. eCollection 2023.

Abstract

Background: Aspergillus fumigatus is an opportunistic fungal pathogen, which is commonly found in lungs and rarely causes infections in mediastinum. Mediastinal Aspergillus abscess is a serious infectious condition, and is characterized by difficult diagnosis due to its clinical manifestations being nonspecific.

Case presentation: Here, we report a case of a mediastinal Aspergillus fumigatus abscess in an immunocompetent patient. The patient was a 45-year-old woman who presented with a 20-day history of sore throat without any underlying diseases. Chest computed tomography (CT) showed a mass in the anterior superior mediastinum. Metagenomic next-generation sequencing (mNGS) identified Aspergillus fumigatus sequences in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) tissue, indicating the mediastinal Aspergillus fumigatus infection of this patient. The following mediastinal biopsy histological analysis and tissue fungi culture also suggested Aspergillus fumigatus infection, confirming the mNGS detection. The patient was diagnosed with mediastinal aspergillosis caused by Aspergillus fumigatus. After timely voriconazole treatment, the patient was discharged with good condition.

Conclusion: Our study presented a rare case with mediastinal Aspergillus fumigatus abscess in an immunocompetent patient. As a new clinical diagnostic method, mNGS could assist timely diagnosis and precise treatment of Aspergillus infection.

Keywords: Aspergillus fumigatus; case report; diagnosis; mediastinal abscess; metagenomic next-generation sequencing.

Publication types

  • Case Reports

Grants and funding

This work was supported by National Natural Science Foundation of China (No. 82260023, 82104499, 82160783, and 81760743); the Natural Science Foundation of Guangxi Province (No. 2022GXNSFAA035646); the Key Research Program of Guangxi Science and Technology Department (No. AB21196010); the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region, self-funded projects (No. Z20200825); Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention (No. ZZH2020004); The First Affiliated Hospital of Guangxi Medical University Provincial and Ministerial Key Laboratory Cultivation Project: Guangxi Key Laboratory of Tropical Fungi and Mycosis Research (No. YYZS2020006); Guangxi Medical and Health Suitable Technology Development and Popularization Application Project (No. S2019090); the First Affiliated Hospital of Guangxi Medical University Clinical Research Climbing Program Youth Science and Technology Morning Star Program (No. 201903032); Advanced Innovation Teams and Xinghu Scholars Program of Guangxi Medical University.