Pulmonary candidiasis presenting as mycetoma

Abstract

Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was confirmed by biopsy and certain points strongly favoured the diagnosis. The patient was immunocompromised due to uncontrolled diabetes mellitus. Candida albicans was grown from bronchial and repeatedly from sputum samples and Candida antigen was positive from blood in high titre. There was a good clinical as well as radiological response to antifungal therapy and Candida antigen became negative. We emphasize that in the immunosuppressed host, a mycetoma-like lesion may be caused by Candida pulmonary infection.

Keywords: Candida; Haemoptysis; Mycetoma.

Fig. 1

X-ray chest PA view showing non-homogenous opacity, left upper zone

Fig 2

CT thorax showing mycetoma with air crescent in left apico-posterior segment.

Fig 3

X-ray chest PA view post-treatment showing improvement in non-homogenous opacity, left upper zone.

Fig 4

Post-treatment CT thorax showing decreased size of mycetoma with air crescent and increased fi brotic changes.