{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:28:47Z","timestamp":1783610927302,"version":"3.55.0"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,12,31]]},"abstract":"<jats:p>A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.<\/jats:p>\n               <jats:p>Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation. This case demonstrates an atypical presentation of invasive pulmonary aspergillosis in a mildly immunodeficient individual. It highlights the challenges in assessment and management of critically ill patients\u2019 nutrition as well as optimal timing for surgical intervention.<\/jats:p>","DOI":"10.1136\/bcr-2017-222143","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:40:34Z","timestamp":1516236034000},"page":"bcr-2017-222143","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula"],"prefix":"10.1136","volume":"2018","author":[{"given":"Christiana","family":"Page","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Barts Health NHS Trust, St Bartholomew\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6333-5471","authenticated-orcid":false,"given":"Laura","family":"Blazy","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Saint George\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Saint George\u2019s Healthcare NHS Trust, St George\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalba","family":"Spiritoso","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Barts Health NHS Trust, St Bartholomew\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,1,17]]},"reference":[{"key":"2025082701035605000_2018.jan17_1.bcr-2017-222143.1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s13054-016-1326-1","article-title":"Does galactomannan testing increase diagnostic accuracy for IPA in the ICU? 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Is Bulpa criteria suitable for the diagnosis of probable invasive pulmonary Aspergillosis in critically ill patients with chronic obstructive pulmonary disease? A comparative study with EORTC\/ MSG and ICU criteria. BMC Infect Dis 2017;17.doi:10.1186\/s12879-017-2307-y","DOI":"10.1186\/s12879-017-2307-y"},{"key":"2025082701035605000_2018.jan17_1.bcr-2017-222143.6","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/2049-6958-8-59","article-title":"Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease","volume":"8","author":"Tutar","year":"2013","journal-title":"Multidiscip Respir Med"},{"key":"2025082701035605000_2018.jan17_1.bcr-2017-222143.7","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00583-2015"},{"key":"2025082701035605000_2018.jan17_1.bcr-2017-222143.8","unstructured":"Pierson D , Luks A . 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