A CASE OF INVASIVE FUNGAL ASPERGILLOSIS – A DIAGNOSTIC CONUNDRUM

Abstract

In clinical practice, Pyrexia of Unknown Origin often presents a diagnostic conundrum, 
bridging diverse specialties such as rheumatology, endocrinology, oncology, haematology, and 
infectious disease. Defining PUO as per Petersdorf and Beeson, later refined by Durack and 
Street, involves persistent fever of 38.3°C or higher for over three weeks, eluding diagnosis 
despite extensive evaluations over three inpatient days or outpatient visits[1,2]
.
Here we present a case of invasive fungal aspergillosis in an elderly male patient, presenting
with a history of persistence of fever and cough, requiring a prolonged hospitalization that 
posed a challenge to arrive at an appropriate diagnosis on time, despite the extensive diagnostic 
workup of pyrexia. 
In India, PUO primarily stems from inflammatory, autoimmune and infectious etiologies, with 
infections comprising over 40% of cases [3]. However, current diagnostics leave over 50% of 
PUO cases unexplained, highlighting a significant gap in medical understanding and the need 
for continued research in this challenging medical phenomenon [4]
.
This case report emphasises on the significance of a systemic workup for PUO and the 
treatment dilemma despite meticulous and extensive availability of biochemical and 
radiological investigations.