{
  "abstract": "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.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’ nutrition as well as optimal timing for surgical intervention.",
  "authors": [
    {
      "affiliations": [
        "Department of Intensive Care, Barts Health NHS Trust, St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Christiana Page"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Saint George’s Hospital, London, UK"
      ],
      "name": "Laura Blazy"
    },
    {
      "affiliations": [
        "Department of Thoracic Surgery, Saint George’s Healthcare NHS Trust, St George’s Hospital, London, UK"
      ],
      "name": "Melanie Jenkins"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Barts Health NHS Trust, St Bartholomew’s Hospital, London, UK"
      ],
      "name": "Rosalba Spiritoso"
    }
  ],
  "title": "Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula",
  "uid": "75cd823d-96b4-5cff-a5dc-16d3787e8fc7"
}