1218 - Pulmonary Rehabilitation Challenges in Aspergillus Pneumonia: A Case Report

A 66-year-old female with Waldenström macroglobulinemia (on Imbruvica), chronic hepatitis B (on entecavir), hypothyroidism, and paroxysmal atrial fibrillation with recurrent hospitalizations for acute hypoxemic respiratory failure. Initially diagnosed with influenza A, she later developed secondary Aspergillus pneumonia, confirmed via bronchoscopy. Despite voriconazole therapy, she experienced persistent hypoxemia, bilateral pleural effusions, and progressive functional decline. Prior to hospitalization, she was independent in mobility and self-care. Upon rehab admission, she required 2L O₂ and exhibited bilateral lower extremity weakness (3-/5 to 3/5), exertional desaturation, and ambulatory instability. 

Discussions:

The patient demonstrated gradual functional improvement during rehabilitation. She progressed from requiring assistance with mobility to ambulating 160 feet with a rolling walker and an additional 120 + 80 feet without an assistive device. She regained independence in grooming and upper-body dressing with minimal aid for lower-body dressing and toilet transfers. Oxygen titration was crucial in managing exertional desaturation, as her oxygen saturation during exertion declined to 82% but reached  92-93% after rest breaks. Although her endurance improved, she continued to experience mild exertional dyspnea and persistent lower extremity weakness, necessitating pacing strategies and continued therapy.

Unlike COPD-focused rehab protocols, immunocompromised patients with opportunistic infections require individualized approaches that account for their variable oxygen demands, medication side effects, and systemic complications. Standard progressive exertion models must be adapted to include prevention strategies for hypoxia exacerbation while maximizing functional recovery.

Conclusions: This case highlights the need for flexible, multidisciplinary rehabilitation strategies in patients with prolonged infectious courses and immunosuppression. A one-size-fits-all pulmonary rehab model may not be sufficient, emphasizing the need for patient-specific  treatment plans to optimize outcomes. Further research is warranted to establish best practices for non-COPD pulmonary rehabilitation.