14 May 2026
: Case report 
A 56-Year-Old Male Farmer From China With Severe Fever With Thrombocytopenia Syndrome and Pulmonary Aspergillosis: A Case Report and Review of Literature
Unusual clinical course
Xiaoheng Lai
ACEF 1*, Quanyuan Gao BCG 1, Lifang Wu AD 1
DOI: 10.12659/AJCR.951798
Am J Case Rep 2026; 27:e951798
Table 2 Literature review of published cases of SAPA.
| Reference | Sex/ age | Epidemio-logy | Underlying condition | Clinical symptoms | Etiology | Treatment | Organs/Systems | Outcome |
|---|---|---|---|---|---|---|---|---|
| Chu 2022 []14 | M/74 | NR | CHD; COPD | Fever, chills, dizziness, headache, cough, sputum production, fatigue | Blood NGS: | Ribavirin; Ceftriaxone/Tazobactam; Voriconazole | Liver, heart, pancreas | Survived |
| Shang 2017 []15 | M/47 | Orchard work; Suspected tick bite | None | Fever, fatigue, cough, sputum production, nausea, vomiting, scattered petechiae and ecchymosis on the body | Sputum culture: , ; G(+); GM(+) | Antiviral (unspecified); Cephalosporin, Tigecycline, Imipenem; Voriconazole | Liver, kidney, heart, coagulation | Survived |
| Cheng 2013 []16 | M/59 | Residence in a hilly area; suspected tick bite | Hyperten-sion | Feeling cold, fever, fatigue, myalgia in limbs, headache, diarrhea | Sputum culture: spp., ; G(+); GM(+) | Ribavirin; Doxycycline, Moxifloxacin, Biapenem; Voriconazole | Liver, heart, coagulation | Survived |
| Luo 2025 []17 | F/57 | History of tick bite | None | Fever, fatigue, decreased appetite, generalized myalgia | BALF NGS: ; CSF NGS: ; G(+); GM(+) | Antiviral (unspecified), IVIG; Voriconazole, Amphotericin B | Liver, heart, pancreas, coagulation | Died |
| Zhang 2024 []18 | M/67 | History of tick bite | None | Fever, feeling cold, chills, fatigue, loss of appetite, headache, generalized myalgia | BALF NGS: ; G(+); GM(+) | Ribavirin, IVIG; Cefoperazone/Sulbactam, Meropenem; Voriconazole, Caspofungin | Liver, kidney | Died |
| Cui 2025 []19 | M/69 | NR | None | Fever, fatigue, cough, sputum production, diarrhea, lip and hand tremors, headache | Sputum culture: spp.; | Ribavirin, IVIG; Levofloxacin; Voriconazole; Methylpre-dnisolone | Liver, kidney, heart, coagulation | Survived |
| Xie 2024 []20 | M/51 | Residence in a suburban area | Hypertension; diabetes | Fever, chest tightness, chest pain, abdominal pain, impaired consciousness, convulsions | BALF NGS: , ; G(+); GM(+) | Ribavirin, IVIG; Imipenem, Cefoperazone/ Sulbactam; Voriconazole, Isavuconazole; Methylpre-dnisolone | Liver, pancreas, coagulation | Survived |
| Xu 2024 []21 | F/65 | Farmer, injury from crayfish traps | Duodenal ulcer; fatty liver disease; hyperli-pidemia | Fever, diarrhea, urinary frequency, memory loss, aphasia, dizziness, chest tightness, drowsiness, multi-site bleeding (pulmonary, gastrointestinal, gingival) | Sputum culture: spp., , ; CSF NGS: SFTSV | Ribavirin, IVIG; Meropenem, Vancomycin | Liver, kidney, heart, brain, coagulation | Died |
| Li 2025 []22 | M/55 | Residence in a mounta-inous area | Diabetes | Fever, fatigue, diarrhea, dizziness, headache, convulsions, limb stiffness, right-sided weakness | CSF NGS: ; CSF culture: MRSA | Favipiravir; Linezolid; Isavuconazole, Amphotericin B; Dexamethasone | Liver, heart, coagulation | Survived |
| Meng 2023 []23 | F/58 | Farmer | None | Fever, fatigue, generalized myalgia, diarrhea, chest tightness, shortness of breath, confusion, convulsions, petechiae on chest, abdomen, and lower limbs | Blood & BALF NGS: , , ; Sputum culture: ; G(+); GM(+) | Ribavirin; Biapenem, Tigecycline; Voriconazole | Liver, kidney, heart | Died |
| Ren 2025 []24 | M/69 | Farmer; history of tick bite | None | Fever, generalized myalgia, lower limb weakness, tonic-clonic seizures, impaired consciousness | BALF NGS: , ; Blood NGS: , Actino-mucor elegans; G(+); GM(+); Pseudomem-brane | IVIG, Ribavirin, Favipiravir; Minocycline, Levofloxacin, Imipenem; Voriconazole, Posaconazole, Amphotericin B, Isavuconazole | Liver, kidney | Survived |
| Zhao 2025 []25 | M/66 | Farmer | Hypertension; atrial fibrillation | Fever, diarrhea, confusion, drowsiness, headache, abdominal pain, urinary incontinence, neck stiffness, muscle weakness, vision loss | Vegetation culture: ; G(+); GM(+) | Ribavirin, Acyclovir, IVIG; Ceftazidime, Levofloxacin, Meropenem, Linezolid, Piperacillin/ Tazobactam; Voriconazole; Methylpre-dnisolone | Kidney, heart, spleen, brain, coagulation | Survived |
| Sakaguchi 2019 []26 | F/91 | History of tick bite | Hypertension; hyperli-pidemia | Fever, vomiting, diarrhea, generalized myalgia, fatigue, impaired consciousness, shock | BALF culture: ; G(+); GM(+); Pseudome-mbranous; Pathology(+) | Minocycline, Piperacillin/Tazobactam; Voriconazole, Micafungin | Liver, kidney, coagulation | Survived |
| All patients had detectable SFTSV RNA in peripheral blood. BALF – bronchoalveolar lavage fluid; CHD – coronary heart disease; COPD – chronic obstructive pulmonary disease; CSF – cerebrospinal fluid; F, female; G – (1–3)-β-D-glucan; GM – galactomannan; IVIG – intravenous immunoglobulin; M – male; MRSA – methicillin-resistant ; NR – not reported; NGS – next-generation sequencing; SFTSV – severe fever with thrombocytopenia syndrome virus; SAPA – severe fever with thrombocytopenia syndrome associated pulmonary aspergillosis. | ||||||||