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BMJ Case Reports 2018; doi:10.1136/bcr-2017-222792
  • Rare disease
  • CASE REPORT

Rare cause of pulmonary cavitation in a 75-year-old man

  1. Ayaaz Habib4
  1. 1Department of General Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
  2. 2Cardiology, Nottingham City Hospital, Nottingham, UK
  3. 3Birmingham City Hospital, Birmingham, UK
  4. 4Department of Critical Care, Queen’s Medical Centre, Nottingham, UK
  1. Correspondence to Dr Jaffar Al-Sheikhli, jaffaralsheikhli{at}doctors.org.uk
  • Accepted 21 December 2017
  • Published 10 January 2018

Summary

A 75-year-old man of Asian descent presented to the acute medical unit with signs and symptoms suggestive of a community-acquired pneumonia. He had multiple comorbidities and was relatively immunocompromised as a result. Initial investigations supported the diagnosis of community-acquired pneumonia complicated by a cavitating lung lesion, and the patient was treated as per hospital guidelines. He continued to deteriorate despite appropriate therapy and developed a hydropneumothorax, requiring the insertion of a chest drain. A diagnosis of pulmonary mucormycosis (Rhizopus microsporus) was made based on microbiology results from pleural aspirate, and patient was treated with intravenous antifungals. The patient was referred to the thoracic team for consideration of surgical intervention but was not suitable due to his multiple comorbidities. This case highlighted the importance of early consideration of fungal infection in patients with multiple risk factors and the need for aggressive therapy to ensure the best outcome.

Footnotes

  • Contributors JA-S was involved in the care of the patient and obtained consent for the report. JA-S along with HT was involved in writing the summary, background, case presentation, differential diagnosis and treatment sections of the case report and reviewed the discussion section. HT was involved in writing the summary, background and case presentation sections; reviewed and modified the discussion section. JD wrote the discussion section of the case report. AH aided in writing the case summary; reviewed the initial draft and reduced the word count to below 2000, as required by the journal.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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