Lobar pneumonia - Fungal infection

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Lobar pneumonia - Fungal infection

  • Lobar pneumonia is usually caused by typical organisms – such as Streptococcus pneumoniae – but may also be caused by atypical organisms – as in this patient
  • The consolidation obscures the left heart border indicating it is in the adjacent lingula of the left upper lobe
  • Pneumonia caused by atypical organisms is more common in individuals who are immunocompromised
  • This patient was immunocompromised due to chemotherapy treatment for leukaemia
  • Fungal elements were found following bronchoscopy and bronchial washing

Pneumocystis pneumonia

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Pneumocystis pneumonia

  • Consolidation seen in a non-lobar distribution should raise the suspicion of atypical organisms
  • This patient with known HIV infection has subtle consolidation in the mid zones bilaterally
  • Although the consolidation appears minor, this patient was extremely unwell with low oxygen saturation which worsened on minor effort (walking down the ward)
  • Pneumocystis pneumonia (PCP) was the diagnosis in this case
  • Note: Initially the chest X-ray can be entirely normal in patients with PCP

Aspergillosis

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Aspergillosis

  • This patient was taking immunosuppressing drugs following a renal transplant
  • Dense consolidation is seen throughout both lungs due to fungal infection – proven to be invasive aspergillosis in this case