Late-Onset Invasive Aspergillosis With Pituitary Involvement and Dysfunction Following CD19 Chimeric Antigen Receptor T-Cell Therapy

INTRODUCTION: Invasive fungal infection (IFI) after chimeric antigen receptor (CAR) T-cell therapy is less common than bacterial and viral infections, but can be fatal once it develops. As most cases occur within 30 days after CAR T-cell infusion, late-onset IFI-particularly mould infection-appears to be under-recognised. DISCUSSION: We report an illustrative case of pituitary aspergillosis developing as late as one year after CD19 CAR T-cell therapy, highlighting a persistent risk in certain patients with delayed immune reconstitution. CONCLUSION: This case underscores the need for continued vigilance and individualised antifungal strategies to prevent IFI beyond the early post-infusion period. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.