CRA63 INVASIVE PULMONARY ASPERGILLOSIS IN AN IMMUNOCOMPETENT PREGNANT AGRICULTURAL WORKER PRESENTING WITH MASSIVE HEMOPTYSIS AND RESPIRATORY FAILURE-

Prisaana Ramakrishnan^1, Rong Li Ho^1, Ian Victor Sooriyaghandan^2, Larry Ellee Nyanti^1,3, Shan Min Lo^1, Hema Yamini, Devi Ramarmuty^1, Kunji Kannan Sivaraman Kannan¹

¹Department of Respiratory Medicine, Queen Elizabeth Hospital, Kota Kinabalu.
²Department of Internal Medicine, Queen Elizabeth Hospital, Kota Kinabalu.
³Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah.

Background
Invasive pulmonary aspergillosis (IPA) typically affects immunocompromised individuals and is rarely reported in pregnancy. However, pregnancy-related immune changes and high environmental exposure may increase susceptibility even in immunocompetent hosts.

Case Presentation
A 42-year-old para 4 at 30 weeks’ gestation, working in an oil palm plantation, presented with mild haemoptysis for two days and a week-long history of productive cough. She was afebrile with saturation of 94% on room air and had generalized crepitations. Chest radiograph demonstrated right lower lobe consolidation. Tuberculosis workup was negative. She deteriorated after an episode of massive haemoptysis and reduced consciousness, requiring intubation. An emergency Caesarean section was performed for maternal and fetal indications. CT angiogram thorax showed no active bleeding. Bronchoscopy revealed dark blood in the right middle lobe with failed adrenaline instillation requiring subsequent lobectomy. Repeat CT showed diffuse pulmonary haemorrhage. Serum and bronchoalveolar lavage galactomannan tests were positive, confirming invasive pulmonary aspergillosis. She was commenced on Voriconazole and was discharged well under room air.

Discussion
Pregnancy induces a Th2-dominant immune shift and impairs neutrophil function, compromising antifungal defences. Occupational exposure to airborne fungal spores in oil palm plantations likely contributed to high inhalational burden. Additional risks included ICU admission, intubation, and surgical stress. This case highlights that even immunocompetent pregnant women can develop IPA when multiple risk factors coexist.

Conclusion
IPA should be considered in pregnant patients with haemoptysis and non-resolving pneumonia, particularly with environmental exposure. Early galactomannan testing may facilitate timely diagnosis and improve outcomes.