{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:26:25Z","timestamp":1771921585290,"version":"3.50.1"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Influenza-associated 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.<\/jats:p>\n <\/jats:sec>\n \n Case description<\/jats:title>\n \n A 34-year-old female presented with a 1-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 (\n \n 190 cmH\n 2<\/jats:sub>\n O\/L\/s\n <\/jats:italic>\n ) and extensive subcutaneous emphysema. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated as a bridge to facilitate diagnostic bronchoscopy, which revealed extensive necrotic pseudomembrane. Subsequent BALF microscopy and mNGS confirmed\n Aspergillus fumigatus<\/jats:italic>\n 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 22 March 2023 and eventually discharged following clinical improvement.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n VV-ECMO combined with repeated bronchoscopic interventions can serve as a rescue strategy in selected patients with airway-invasive IAPA and refractory respiratory failure.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1732770","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T06:46:55Z","timestamp":1771915615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extracorporeal membrane oxygenation therapy for severe influenza-associated pulmonary aspergillosis: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Cuijie","family":"Tian","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Henan Provincial People\u2019s Hospital, Zhengzhou","place":["Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaofan","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Zhengzhou University People\u2019s Hospital, Henan Provincial People\u2019s Hospital, Zhengzhou","place":["Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Zhengzhou University People\u2019s Hospital, Henan Provincial People\u2019s Hospital, Zhengzhou","place":["Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoju","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Henan Provincial People\u2019s Hospital, Zhengzhou","place":["Henan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1038\/s41572-018-0002-y","article-title":"Influenza.","volume":"4","author":"Krammer","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1016\/S2213-2600(18)30274-1","article-title":"Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study.","volume":"6","author":"Schauwvlieghe","year":"2018","journal-title":"Lancet Respir Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1007\/s00134-020-06091-6","article-title":"Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion.","volume":"46","author":"Verweij","year":"2020","journal-title":"Intensive Care Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1016\/S2213-2600(24)00151-6","article-title":"Influenza-associated and COVID-19-associated pulmonary aspergillosis in critically ill patients.","volume":"12","author":"Feys","year":"2024","journal-title":"Lancet Respir Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1136\/thorax-2021-218375","article-title":"Novel inhaled antifungal for pseudomembranous Aspergillus tracheobronchitis complicating connective tissue disease.","volume":"78","author":"Singh","year":"2023","journal-title":"Thorax"},{"key":"B6","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S2213-2600(21)00138-7","article-title":"COVID-19-associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion.","volume":"9","author":"van de Veerdonk","year":"2021","journal-title":"Lancet Respir Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group education and research consortium.","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B8","doi-asserted-by":"publisher","first-page":"105347","DOI":"10.1016\/j.ebiom.2024.105347","article-title":"Damping excessive viral-induced IFN-\u03b3 rescues the impaired anti-Aspergillus host immune response in influenza-associated pulmonary aspergillosis.","volume":"108","author":"Seldeslachts","year":"2024","journal-title":"EBioMedicine"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.","volume":"378","author":"Combes","year":"2018","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1732770\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T06:46:55Z","timestamp":1771915615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1732770\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":9,"alternative-id":["10.3389\/fmed.2026.1732770"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1732770","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]},"article-number":"1732770"}}