Invasive candidiasis includes candidemia and disseminated infection and is rarely associated with pneumonia, as Candida species are most often considered colonizers of the respiratory tract. However, debate persists about Candida as a true etiologic agent of fungal lung disease, particularly in immunosuppressed or critically ill patients, making the decision to start antifungal therapy challenging. This case report describes a 54-year-old man with multiple comorbidities admitted to a tertiary hospital in Paraná with confusion, cough, progressive dyspnea, lower-limb edema, and weight loss. He progressed to septic shock with probable pulmonary focus, chest X-ray showing bronchoaspiration-pattern consolidation, requiring intubation. He was initially treated with ceftriaxone and azithromycin but had poor clinical and laboratory response, with worsening appearance and quantity of secretions in the endotracheal tube. A repeat chest CT after seven days showed pleural effusion and signs of necrotizing pneumonia with lung abscess. Tracheal aspirate, bronchoscopy with bronchial lavage and bronchoalveolar lavage were collected. He required pleural drainage and pulmonary decortication with material sent for microbiology and pathology. Candida tropicalis grew from all collected samples, and histopathology of lung parenchyma biopsy showed fungal structures (hyphae and spores) invading the vascular wall. Treatment was guided by susceptibility testing, with fluconazole for six weeks, leading to clinical and radiologic improvement. This report aims to present and discuss clinical, laboratory, radiologic, and histopathologic data supporting the diagnosis of angioinvasive Candida pneumonia, given ongoing controversies, and to reinforce the importance of early diagnosis in this scenario.
Secchi et al. (Sun,) studied this question.