Concurrent pulmonary zygomycosis and Mycobacterium tuberculosis infection: a case report

Tejal Patel,Ian J Clifton,Jack A Kastelik,Daniel G Peckham

doi:10.1186/1752-1947-1-17

Tejal Patel, Ian J Clifton + Show 2 more

Open Access

https://doi.org/10.1186/1752-1947-1-17

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Abstract

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss. CT scan of thorax demonstrated a 2.5 cm mass in the right middle lobe with multiple small nodules within the right lung and confirmed the presence of mediastinal and hilar lymph nodes.Fibreoptic bronchoscopy demonstrated a distorted right main bronchus, anterior shift of the right upper lobe and occlusion of the right middle lobe bronchus with a black necrotic ulcer. Mycobacterium tuberculosis was found in the bronchoalveolar lavage and histology demonstrated numerous fungal hyphae with a morphological appearance of zygomycetes within necrotic areas of tissue. Medical management with anti-fungal and anti-mycobacterial treatment was instigated as the patient's pre-existing IHD did not permit surgical intervention. Subsequently CT imaging following completion of therapy demonstrated improvement of the mass and a resolution of the associated nodules. The patient has been followed for 6 months to date and there has been no recurrence of symptoms. Recent bronchoalveolar lavage cultures have been negative for M. tuberculosis and zygomycetes.

Highlights

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss
He had no past history of Mycobacterium tuberculosis infection but suffered from significant ischaemic heart disease (IHD)
Testing for human immunodeficiency virus (HIV) was not undertaken as the patient was not felt to be at risk for HIV infection

Summary

Introduction

A non-smoking 77-year old gentleman of Indian origin was admitted with a 4-month history of intermittent night sweats, haemoptysis and 6 kg of weight loss. He had no past history of Mycobacterium tuberculosis infection but suffered from significant ischaemic heart disease (IHD). Testing for human immunodeficiency virus (HIV) was not undertaken as the patient was not felt to be at risk for HIV infection. CT scan of thorax demonstrated a 2.5 cm mass in the right middle lobe with multiple small nodules within the right lung and confirmed the presence of mediastinal and hilar lymph nodes.

Results

Conclusion