Polymicrobial Fungal lung abscess

Abstract

A 53-year-old male farmer who was alcoholic came to the hospital with complaints of hemoptysis for 15 days, cough with expectoration for 3 months, low grade fever since 2 months and shortness of breath for one month. Patient was a diabetic for 3 years not on regular treatment. Patient was not a smoker.CT chest: Right upper lobe consolidation with cavitary lesions. Patient was started on Anti Tubercular Treatment(ATT) from outside hospital for which patient was not responding. At our centre initial diagnosis of community acquired pneumonia with sepsis was made.Pleural fluid culture sensitivity had growth of Aspergillus Niger species. KOH mount showed septate fungal hyphae. Procalcitonin was elevated and serum galactomannan was elevated. Patient was diagnosed as polymicrobial fungal lung abscess. Intercoastal drainage tube(ICD) was inserted to drain the fluid.Patient was started on INJ liposomal amphotericin b and meropenem were given for 2 weeks. Pleural fluid was sent for culture sensitivity again and showed growth of aspergillus and Rhizopus. Bronchial artery embolization was done in view of persistent hemoptysis. Subsequently patient improved clinically and was discharged eventually after 2 weeks.Prompt diagnosis and initiation of antifungal therapy is very important in patients with lung abscess who fail to respond to initial antibiotic therapy. Fungal etiology should always be kept in mind in patients of uncontrolled diabetes mellitus with non resolving consolidation progressing to lung abscess.