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• W4387249538 abstract "SESSION TITLE: Chest Infections Case Report Posters 7 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Cavitary lung diseases have a broad range of etiologies out of which infections remain the commonest. Out of the common pathogens, fungi are often the culprits due to subacute presentations and mild symptoms over a longer course of time. Cavitary lesions from geographically endemic pathogens like Coccidioidomycosis and Blastomycosis are well reported and their disease patterns and management are also extensively discussed. We came across a case of a rare fungal pathogen, namely Penicillium species, causing a significant cavitary lung disease. CASE PRESENTATION: An eighty-one year old male with hypertension, dyslipidemia and a prior remote history of smoking with no other diagnosed pulmonary diseases presented to the ER with a worsening cough with intermittent mild hemoptysis over the past 2 weeks. Patient mentioned that he noticed the cough and some chest discomfort more than a month ago which was initially dry which worsened over the course of time until he started noticing mild hemoptysis with it. Initially he attributed it to severe bouts of coughing but it persisted. He had no fevers, chills, weight-loss, known sick contacts or significant exposures in the recent past. He retired as a teacher 15 years back and lived in an urban area. In the ER, the patient was hypoxic only on exertion and chest imaging was done. In light of anemia and persistent cough with hemoptysis, he was admitted inpatient. CT scan, as shown, showed a large cavitary lesion in the right lower lobe. Detailed evaluation through serologies and autoimmune panel was performed and the patient had a Bronchoscopy with Bronchoalveolar lavage sent for analysis. Empiric treatment with antibiotics and bronchodilators partially improved symptoms and the patient was discharged to follow-up outpatient. The microbiology results came back positive with Penicillium species two weeks later. Patient was started on appropriate antifungal therapy outpatient and endorsed symptomatic relief within two weeks of treatment. DISCUSSION: Cavitary lesion formation in the lungs is generally secondary to a slow process, either infectious, inflammatory or malignant. Penicillium is also one globally present fungal organism that is generally not pathogenic but multiple cases of skin disease and wound infections from the organism are widely reported. Pulmonary involvement in the form of a cavitary lung disease is rare and sparsely reported in the western world. Most reported cases have involved immunocompromised or immunosuppressed hosts, notably HIV patients*1 and the disease has occasionally been disseminated as well. Predominance in coastal areas has also been reported more, likely associated with humidity which aids in the growth of the fungus. CONCLUSIONS: Cavitary lung disease from a slow growing fungal disease is well-reported but Penicillium as a pathogen is quite rare. We report such a case which was diagnosed and managed with satisfactory outcomes. REFERENCE #1: https://doi.org/10.1016/j.chest.2018.02.026 REFERENCE #2: https://doi.org/10.1164/rccm.201202-0321IM DISCLOSURES: No relevant relationships by Mohammed Ali No relevant relationships by Asad Chohan No relevant relationships by Saiara Choudhury No relevant relationships by Austin Makadia No relevant relationships by Vishesh Persaud No relevant relationships by Abhay Vakil" @default.
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• W4387249538 date "2023-10-01" @default.
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• W4387249538 title "CAVITARY LUNG DISEASE FROM PENICILLIUM SPECIES" @default.
• W4387249538 doi "https://doi.org/10.1016/j.chest.2023.07.540" @default.
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