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Invasive candidiasis presenting multiple pulmonary cavitary lesions on chest computed tomography.

Yasuda Y, Tobino K, Asaji M, Yamaji Y, Tsuruno K - Multidiscip Respir Med (2015)

Bottom Line: The chest CT scan showed multiple small cavitary lesions and nodules with surrounding ground-glass opacity, and also bilateral pleural effusion.Although this CT finding is thought as specific for pulmonary aspergillosis, two sets of blood culture specimens were drawn which yielded Candida albicans in our case.To our knowledge, this is the first case report describing multiple pulmonary cavitary lesions in invasive candidiasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan.

ABSTRACT
We herein report a case of invasive candidiasis presenting rare findings on chest computed tomography (CT). The chest CT scan showed multiple small cavitary lesions and nodules with surrounding ground-glass opacity, and also bilateral pleural effusion. Although this CT finding is thought as specific for pulmonary aspergillosis, two sets of blood culture specimens were drawn which yielded Candida albicans in our case. Antifungal therapy was started and the chest CT findings showed a remarkable improvement. To our knowledge, this is the first case report describing multiple pulmonary cavitary lesions in invasive candidiasis.

No MeSH data available.


Related in: MedlinePlus

Multiple small cavitary lesions and nodules. Chest CT images obtained on the 14th day of admission showed multiple small cavitary lesions and nodules surrounded by ground-glass opacity, and also bilateral pleural effusion. These lung abnormalities seemed to be in a peribronchovascular distribution.
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Fig2: Multiple small cavitary lesions and nodules. Chest CT images obtained on the 14th day of admission showed multiple small cavitary lesions and nodules surrounded by ground-glass opacity, and also bilateral pleural effusion. These lung abnormalities seemed to be in a peribronchovascular distribution.

Mentions: An 80-year-old man was admitted to our hospital for the treatment of small bowel obstruction. Initial management involved nasogastric tube insertion and fluid resuscitation with central venous (CV) catheters. His small bowel obstruction did not resolve, and on the 8th day, he presented fever and hypoxemia. He had a history of stage IV chronic kidney disease secondary to hypertensive nephrosclerosis for 15 years, and distal gastrectomy for gastric cancer 20 years before. He did not have smoking history and risk factors for HIV infection, and drank alcoholic beverages occasionally. Physical examination revealed poor oral hygiene only. The chest x-ray revealed multiple nodules in the right upper lung field, and also mixed ground-glass and airspace opacities in the entire right lung (Figure 1). The chest CT scan showed multiple small cavitary lesions and nodules surrounded by ground-glass opacities, and also bilateral pleural effusion (Figure 2). Examination of sputum showed no predominant pathogen and no acid-fast organisms on staining. Laboratory tests revealed elevated serum β-D-glucan (483 pg/ml, normal, < 20 pg/ml) positive serum Candida antigen latex agglutination test, and negative serum Aspergillus galactomannan antigen test. Two sets of blood culture specimens were drawn on the 8th day which yielded Candida albicans. Transbronchial biopsy and bronchial washings of the cavitary lesion in the right upper lobe were performed, however, non-specific inflammation of the lung tissue without any bacteria was revealed. Moreover, transbronchial biopsy did not reveal aspergillus hyphae. The patient was diagnosed as affected with invasive candidiasis. Therefore, potentially contaminated CV catheter was removed and antifungal therapy with intravenous fluconazole was started. The patient became afebrile after the 3rd day of the initiation of antifungal therapy, and blood culture of the same day did not yield any organisms. The treatment was continued for three weeks, and on the 15th day of antifungal therapy the chest CT findings showed a remarkable improvement (Figure 3).Figure 1


Invasive candidiasis presenting multiple pulmonary cavitary lesions on chest computed tomography.

Yasuda Y, Tobino K, Asaji M, Yamaji Y, Tsuruno K - Multidiscip Respir Med (2015)

Multiple small cavitary lesions and nodules. Chest CT images obtained on the 14th day of admission showed multiple small cavitary lesions and nodules surrounded by ground-glass opacity, and also bilateral pleural effusion. These lung abnormalities seemed to be in a peribronchovascular distribution.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374287&req=5

Fig2: Multiple small cavitary lesions and nodules. Chest CT images obtained on the 14th day of admission showed multiple small cavitary lesions and nodules surrounded by ground-glass opacity, and also bilateral pleural effusion. These lung abnormalities seemed to be in a peribronchovascular distribution.
Mentions: An 80-year-old man was admitted to our hospital for the treatment of small bowel obstruction. Initial management involved nasogastric tube insertion and fluid resuscitation with central venous (CV) catheters. His small bowel obstruction did not resolve, and on the 8th day, he presented fever and hypoxemia. He had a history of stage IV chronic kidney disease secondary to hypertensive nephrosclerosis for 15 years, and distal gastrectomy for gastric cancer 20 years before. He did not have smoking history and risk factors for HIV infection, and drank alcoholic beverages occasionally. Physical examination revealed poor oral hygiene only. The chest x-ray revealed multiple nodules in the right upper lung field, and also mixed ground-glass and airspace opacities in the entire right lung (Figure 1). The chest CT scan showed multiple small cavitary lesions and nodules surrounded by ground-glass opacities, and also bilateral pleural effusion (Figure 2). Examination of sputum showed no predominant pathogen and no acid-fast organisms on staining. Laboratory tests revealed elevated serum β-D-glucan (483 pg/ml, normal, < 20 pg/ml) positive serum Candida antigen latex agglutination test, and negative serum Aspergillus galactomannan antigen test. Two sets of blood culture specimens were drawn on the 8th day which yielded Candida albicans. Transbronchial biopsy and bronchial washings of the cavitary lesion in the right upper lobe were performed, however, non-specific inflammation of the lung tissue without any bacteria was revealed. Moreover, transbronchial biopsy did not reveal aspergillus hyphae. The patient was diagnosed as affected with invasive candidiasis. Therefore, potentially contaminated CV catheter was removed and antifungal therapy with intravenous fluconazole was started. The patient became afebrile after the 3rd day of the initiation of antifungal therapy, and blood culture of the same day did not yield any organisms. The treatment was continued for three weeks, and on the 15th day of antifungal therapy the chest CT findings showed a remarkable improvement (Figure 3).Figure 1

Bottom Line: The chest CT scan showed multiple small cavitary lesions and nodules with surrounding ground-glass opacity, and also bilateral pleural effusion.Although this CT finding is thought as specific for pulmonary aspergillosis, two sets of blood culture specimens were drawn which yielded Candida albicans in our case.To our knowledge, this is the first case report describing multiple pulmonary cavitary lesions in invasive candidiasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018 Japan.

ABSTRACT
We herein report a case of invasive candidiasis presenting rare findings on chest computed tomography (CT). The chest CT scan showed multiple small cavitary lesions and nodules with surrounding ground-glass opacity, and also bilateral pleural effusion. Although this CT finding is thought as specific for pulmonary aspergillosis, two sets of blood culture specimens were drawn which yielded Candida albicans in our case. Antifungal therapy was started and the chest CT findings showed a remarkable improvement. To our knowledge, this is the first case report describing multiple pulmonary cavitary lesions in invasive candidiasis.

No MeSH data available.


Related in: MedlinePlus