Candida is frequently isolated from the respiratory tract and usually reflects airway colonization. True Candida pneumonia is rare. Our aim is to document a case of Candida pneumonia confirmed by cultures, molecular techniques, and surgical lung biopsy, and to highlight a previously unreported pathologic manifestation of this infection.
A 59-year-old man with a history of chronic obstructive pulmonary disease (COPD) presented with dry cough, low-grade fever, and progressive dyspnea. He was eventually diagnosed with sarcoidosis based on bilateral lung infiltrates and granulomas in a transbronchial biopsy. His condition worsened after immunosuppression, prompting surgical lung biopsy, which revealed suppurative granulomas containing Candida albicans, confirmed by cultures and polymerase chain reaction. Despite multiple episodes of respiratory failure and a prolonged course in intensive care, he recovered fully after antifungal therapy and is currently alive with COPD-related dyspnea 3 years after his initial presentation.
Candida can rarely cause clinically significant pneumonia in adults, and should be considered in the differential diagnosis of suppurative granulomas in the lung.
aDepartment of Pathology, Pathology and Laboratory Medicine Institute
bImaging Institute, Cleveland Clinic
cInfectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
dInfectious Disease, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio.
Correspondence: Sanjay Mukhopadhyay, Department of Pathology, Cleveland Clinic, Cleveland, OH 44195 (e-mail: email@example.com).
Abbreviations: BAL = bronchoalveolar lavage, COPD = chronic obstructive pulmonary disease, CT = computed tomogram, GMS = Grocott methenamine silver, IDSA = infectious diseases society of America, NCEZID = national center for emerging and zoonotic infectious diseases, PCR = polymerase chain reaction.
The authors have no conflicts of interest to disclose.
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Received November 28, 2017
Accepted December 27, 2017