The document presents a case of fungal pneumonia in a 74-year-old male with liver cirrhosis. Initial investigations revealed bilateral lung consolidation on chest X-ray and CT scan. The patient was admitted with symptoms of exertional dyspnea, cough, night sweats, fever, and weight loss. Treatment for fungal pneumonia was started including oxygen therapy, nebulizers, IV fluids, antibiotics, and antifungals. Follow up labs showed worsening leukocytosis and respiratory acidosis. A diagnosis of fungal pneumonia was considered most likely given the patient's risk factors and imaging findings.

1. Case Presentation
Fungal pneumonia
By :-
Dr. Fawzia Aboafia ( internal medicine residence doctor).
Dr. Hana Ibrahim ( intern doctor at Ibn sina Hospital ) .
Dr. Salah ali muftah ( intern doctor at ibn sina hospital ) .

2. Case Scenario
 74 yrs old FLP K/C of liver cirrhosis 2ry To HBV e Hx distal hepato-renal
shunt Since 1980 on R ttt by hepamerz sachet , Multivitamin & omega 3
syrups .
 Presented to us e Hx exertional dyspnea Progress to dyspnea at rest ,
dry cough , night sweating , fever , chocking & weight loss as family
Saied , Hx of oral thrush ttt by nystatin oral drop.
 O/E :- ptn was conscious , confused , looks ill , tachypnic , febrile &
underweight , no pedal odema.
 Vitally :- BP = 100/60 mmHg , PR = 111 bpm , Temp = 38 c , Spo2 = 79 %
on room air.
 Chest :- decrease AE B/L e fine crepitation at middle zone.
 CVS :- s1 s2 audible .
 P/A :- soft lax e generalized tenderness , +ve bowel sound

3. Case Scenario
 Ptn admitted to FMW , base line investigation collected.
 CXR revealed B/L consolidation.
 HRCT revealed dense mass-like consolidation in B/L lungs e
surrounding areas of ground glass opacities , Most Likely
Fungal pneumonia B/C it takes multilobles in distribution.
 according to all data , we suspect fungal pneumonia most likely
Dx & ttt started .
 Ttt:- O2 therapy , Neb , IVF , IV PPI , IV mucolyte , IV AB & Iv
fluconazole

5. .

6. The following investigation done at
admission :-
 Hb = 13.1 g/dl PT = 17.4 sec
 Wbc= 12.770 INR = 1.5
 plt = 346,000 APTT = 36.8
sec.
 ESR = 71mm/hr UREA= 53
mg/dl
 CRP = positive titer =12mg/l Creatinine =
1.0 mg/dl
 AST = 72 iu/L
 ALT = 45 iu/L

7. Hg WBC PLT AST ALT UREA Creatinin ESR CRP
19.2.2020 11.8 8,400 194000
20.2.2020 11.5 13,500 379000 215
IU
54
IU
21.2.2020 12.9
16,170
315,000 244
IU
59
IU
136
mg/dl 0.78mg/d
l
71mm/hr 12mg/L
23.2.2020 14.4
47,000
294,000 210
IU
70
IU
92 mg/dl 1.06
mg/dl
24.2.2020 11.1
26,000
135,000 38
IU
40
IU
89 mg/dl 1.4
mg/dl
25.2.2020 10.7
21,600
203,000 97
IU
49
IU
64 mg/dl 0.4
mg/dl
27.2.2020

8.  ABG :- Respiratory acidosis
 Electrolytes :- was within normal
 AFB :- requested and not done.
 SUPUTUM CULTURE :- requested and not done.

9. Fungal Pneumonia
WHAT IS PNEUMONIA??
Pneumonia Is An Infection
Of One Or Both
Lungs.
Which Is Usually Caused By
Bacteria,
Viruses, Or Fungi

10. • Fungal pneumonia is a type of lung infection caused by
fungi
• uncommon in most people , those with compromised
immune systems due to certain types of infection such
as HIV are at an increased risk of developing fungal
pneumonia.
• Mortality rate in fungal pneumonias can be as high as
90%

11. ◦What’s your differential
diagnosis …???

12. Non contrast CT chest :-