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Lung nodules due to Candida parapsilosis in a person with cystic fibrosis
  1. Mary Bryson Piechowiak1,
  2. Anne Whitney Brown2,
  3. Shambhu Aryal2 and
  4. Shalika Basnayake Katugaha2,3
  1. 1Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA
  2. 2Adult Cystic Fibrosis Program, Inova Fairfax Hospital, Falls Church, Virginia, USA
  3. 3Division of Infectious Diseases, Baptist Health, Jacksonville, Florida, USA
  1. Correspondence to Dr Mary Bryson Piechowiak; mary.piechowiak1{at}


We present the first reported case of Candida parapsilosis pulmonary infection presenting as lung nodules. The patient is a 31-year-old man with cystic fibrosis (CF) colonised with multidrug-resistant Escherichia coli and increased frequency of pulmonary exacerbations in the preceding months. While on intravenous antibiotics for a pulmonary exacerbation, he developed bilateral pulmonary nodules. Bronchoalveolar lavage cultures grew C. parapsilosis. He was initially treated with dual antifungal therapy, voriconazole and micafungin. Discontinuation of voriconazole due to transaminitis resulted in the development of new nodules, and isavuconazonium was added. Repeat imaging revealed no progression of disease. Micafungin was eventually discontinued. Monotherapy with isavuconazonium is planned for 1 year post lung transplant. In the CF population, C. parapsilosis may be an opportunistic pathogen. The case highlights that frequent CF exacerbations and antibiotic exposure increase the risk for opportunistic infections including Candida species and the implications for lung transplantation in this setting.

  • cystic fibrosis
  • infections
  • radiology
  • TB and other respiratory infections
  • pneumonia (infectious disease)

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  • Contributors SBK, SA and AWB managed the patient case. SBK identified case for publication. MBP did literature review and wrote article. All authors contributed to editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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