Management of Severe Fever with Thrombocytopenia Syndrome-Associated Encephalopathy with Mixed Pulmonary Mold Infections: A Case Report

Abstract

Introduction: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease of global concern. This case report describes a patient with SFTS-associated encephalopathy complicated by mixed pulmonary infections with Aspergillus fumigatus and Rhizopus microsporus in Ningbo, China — a combination that has not been previously reported. Case Presentation: A forty-five-year-old man with confirmed severe fever with thrombocytopenia syndrome virus (SFTSV) infection developed pulmonary co-infection by Aspergillus and Rhizopus, complicated by massive hemoptysis. He received combined antifungal therapy with liposomal amphotericin B and isavuconazole, as well as bronchoscopy and bronchial artery embolization (BAE). Due to recurrent hemoptysis, a left lower lobectomy was performed, resulting in complete clinical and radiological recovery. Conclusions: This case highlights the importance of early recognition and dynamic reassessment of fungal infections in SFTS patients. Prompt initiation of broad-spectrum antifungal therapy and timely surgical intervention are key to improving survival. Nevertheless, as a single case, the findings should be interpreted cautiously; further studies are needed to determine whether similar dual fungal infections occur more widely in SFTS patients or under specific immunosuppressive conditions.