Negative (1,3)-β-D-glucan and Elevated White Blood Cells Combined Procalcitonin Masquerading as Severe Pneumonia Eventually Diagnosed as Invasive Pulmonary Aspergillosis Proven by Bronchoalveolar Lavage Fluid Culture in a Diabetes Patient: a Case Report and Literature Review

Background: We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-beta-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture. Methods: Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture. Results: Serum (1,3)-beta-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus. Conclusions: Negative (1,3)-beta-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.