Abstract
Invasive pulmonary aspergillosis usually occurs in severely immunocompromised or neutropaenic patients. We describe an immunocompetent patient with no pre-existing lung disease admitted to Intensive Care Unit with acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF), 5 days following uncomplicated hip replacement. Despite supportive treatment, antibiotics and high dose steroids (started on 7th ARDS day) the patient died. All bacteriology samples were negative. Serology for influenza A was raised at titre of 1:256. Post mortem examination showed evidence of ARDS, squamous metaplasia (typically seen following viral infection) and invasive aspergillosis. As CT scan of the chest is valuable in diagnosing invasive aspergillosis, (by either showing characteristic CT features or helping in guiding further diagnostic procedures e.g. bronchoalveolar lavage, needle biopsy or open lung biopsy) we suggest that a CT scan of the chest should be performed, either before starting steroids or 2-3 post steroid treatment (if no clinical improvement), to exclude the possibility of invasive aspergillosis in unresolving ARDS.