Case Report: Invasive Pulmonary Infection Caused by Conidiobolus Sp. With a Miliary Pattern in a Patient With Acquired Immunodeficiency Syndrome – First Report in the Literature

Conidiobolus sp. are considered low-virulence fungi found in tropical and subtropical regions. Infection occurs through cutaneous inoculation via injured skin, reptile and amphibian bites, and less frequently by inhalation of spores. Since the first case described in 1961, reported manifestations have been mainly subcutaneous infections, with systemic disease being extremely uncommon and occurring predominantly in immunosuppressed patients. The typical presentation includes painless and progressive swelling of the skin and soft tissues, involving the face, evolving into firm, adherent subcutaneous nodules that may cause anatomical deformities. In more advanced stages, lymphatic vessel involvement may occur. Pulmonary involvement described to date includes focal consolidations, nodules, and masses. We present the case of a 25-year-old man from Northern Brazil, residing in an urban area with a subtropical climate, previously healthy. He presented with weight loss, intense productive cough, daily nocturnal fever, pleuritic chest pain, progressive dyspnea, and the appearance of an ulcerated lesion at the right labial commissure for approximately one month. Chest CT revealed multiple randomly distributed bilateral miliary micronodules smaller than 3 mm (a chest CT performed one month earlier showed only fibroatelectatic bands in the left basal segment). Given the clinical presentation and Brazilian epidemiological context, tuberculosis and human immunodeficiency virus (HIV) infection were investigated. HIV infection was confirmed with a CD4 count of 27 cells/mm³, while acid-fast bacilli tests were negative. Due to the absence of a definitive diagnosis, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed, revealing invasive pulmonary infection caused by Conidiobolus sp. Pulmonary involvement is rarely described in the literature, and to date, this is the first report with a miliary pattern. This case reinforces the importance of including rare fungal infections in the differential diagnosis of immunosuppressed patients and highlights the need for careful clinical and laboratory surveillance for early diagnosis and appropriate intervention.