A 70-Year-Old Woman with Cough and Shortness of Breath

This case describes a 70-year-old woman from KwaZulu-Natal, South Africa with advanced HIV infection (CD4 <10 cells/μL), presenting with progressive cough, dyspnea, and constitutional symptoms. She had a history of pulmonary tuberculosis and SARS-CoV-2 infection, and developed oral candidiasis, buccal ulcers, and later headaches with cranial nerve palsies. RT-PCR testing revealed persistent SARS-CoV-2 RNA positivity spanning >11 months with intrahost viral evolution (F486V spike mutation, S gene deletion). Imaging identified a cavernous sinus mass with carotid occlusion. Sputum cultures yielded Aspergillus fumigatus, and she was diagnosed with rhinocerebral aspergillosis superinfection in the context of SARS-CoV-2 persistence and profound immunosuppression. Despite ART intensification (tenofovir, lamivudine, dolutegravir), the patient died during hospitalization.

This case describes a 70-year-old woman from KwaZulu-Natal, South Africa with advanced HIV infection (CD4 <10 cells/μL), presenting with progressive cough, dyspnea, and constitutional symptoms. She had a history of pulmonary tuberculosis and SARS-CoV-2 infection, and developed oral candidiasis, buccal ulcers, and later headaches with cranial nerve palsies. RT-PCR testing revealed persistent SARS-CoV-2 RNA positivity spanning >11 months with intrahost viral evolution (F486V spike mutation, S gene deletion). Imaging identified a cavernous sinus mass with carotid occlusion. Sputum cultures yielded Aspergillus fumigatus, and she was diagnosed with rhinocerebral aspergillosis superinfection in the context of SARS-CoV-2 persistence and profound immunosuppression. Despite ART intensification (tenofovir, lamivudine, dolutegravir), the patient died during hospitalization.