WP2.14 - Lung Mycetoma - Chronicles from the Pandemic

Abstract

Abstract Introduction COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection. Case Study A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period. Conclusion Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.