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

BMJ Case Rep. 2018 Jan 10:2018:bcr2017222792. doi: 10.1136/bcr-2017-222792.

Abstract

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.

Keywords: infectious diseases; pneumonia (respiratory medicine); respiratory medicine.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antifungal Agents / therapeutic use*
  • Community-Acquired Infections / complications*
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology
  • Humans
  • Hydropneumothorax / drug therapy
  • Hydropneumothorax / microbiology*
  • Lung Diseases, Fungal / complications*
  • Lung Diseases, Fungal / drug therapy
  • Lung Diseases, Fungal / microbiology
  • Male
  • Mucormycosis / complications*
  • Mucormycosis / drug therapy
  • Mucormycosis / microbiology
  • Rhizopus

Substances

  • Antifungal Agents