PMC10393732_01
(A) PA view of X-ray of the chest on 1st ED visit as compared to (B) 3rd ED visit, shows worsening bilateral lower zones infiltrates more pronounced on the right lower zones.
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PA view (Fig. 1) showed worsening bilateral lower zones infiltrates more pronounced on the right lower zones as compared to her 1st ED visit. Patient was treated as a case of sepsis secondary to community acquired pneumonia with intolerance to oral therapy.
(A, B, C & D) HRCT scan cuts show plaque like consolidative changes with lower lobe volume loss, multiple randomly distributed micro-nodules with tree-in bud-appearance with thickening of the peri-broncho-vascualr intersitium.
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High resolution CT scan was done and revealed bilateral basal air space opacities with peri bronchovascular distribution and centrilobular nodules with branching pattern suggestive of tree in bud predominantly in lower lobes (Fig. 2).
Bronchoscopy shows inflamed looking airways, especially right upper lobe secondary carina with inflamed submucosal and mucosal changes.
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Bronchoscopy (Fig. 3) was done on day 9 of admission and showed inflamed looking airways, especially right upper lobe secondary carina with inflamed submucosal and mucosal changes.
Plot chart illustrates progressive decline in crp, wbc and temperature post anti-fungal treatment.
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She fortunately improved dramatically, this was reflected in both her clinical and biochemical status within the first 24hrs of starting anidulafungin (Fig. 4) which she continued intravenously for 4 days then discharged on oral fluconazole for another 20 days based on the susceptibility results.
(A, B & C) post treatment follow up HRCT scan cuts show near complete resolution of the consolidative changes and micronodules as compared to images in Fig. 2.
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She showed complete recovery upon her post discharge follow up both clinically and radiologically (Fig. 5).