CTICasesInvasive Fungal Infection (Aspergillosis) with Diffuse Pulmonary Hemorrhage
Imaging findings
Initial imaging shows diffuse lung opacities consistent with severe pulmonary hemorrhage. Within these opacities, an area of cavitation is identified in the right lower lobe. On a subsequent admission, multiple cavitary lesions are seen in both lower lobes, with some demonstrating an air-crescent sign.
Key takeaways
In immunocompromised patients (e.g., those with SLE), invasive fungal infection, particularly Aspergillosis fumigatus, can occur concomitantly with severe diffuse pulmonary hemorrhage. The hemorrhagic background can initially obscure focal lesions. The development of cavitary lesions, especially with an air-crescent sign, is highly suggestive of invasive fungal infection, supported by positive fungal cultures (BAL) and serum markers (beta-D-glucan).
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