A Neonate With Fungal Lung Nodules Mimicking Pulmonary Malig
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Common causes for neonatal lung masses include developmental abnormalities like pulmonary sequestration, congenital pulmonary airway malformation, bronchogenic cyst, and primary lung tumors. Fungal pneumonia mimicking a radiologic appearance of a malignant lung mass is uncommon in neonates.

A full-term 3-kg male child was symptomatic since day 12 of life when he started with fever, cough, fast breathing, and poor feeding. Chest radiograph revealed a large homogenous opacity in the right upper lung zone. He was initially managed as a case of pneumonia and late-onset sepsis with intravenous (IV) meropenem. There were no signs of improvement even after 5 days of IV antibiotics. Contrast-enhanced computed tomography of the chest showed multiple nodules of varying sizes in both lungs with underlying necrosis. Clinical condition deteriorated, and he required mechanical ventilation from day 20 of illness.

IV liposomal amphotericin B—5?mg/kg/d empirically was initiated. Ultrasound-guided fine-needle aspiration of right lung lesion revealed inflammatory cells and fungal elements suggestive of Aspergillus sp. The antifungal agent was later changed to IV voriconazole (6?mg/kg/d twice daily on the first day, followed by 4?mg/kg/d subsequently) that was continued for next 1 week. However, he succumbed to respiratory failure at day 29 of illness.

This case had a neonatal presentation of autosomal recessive CGD due to NCF1 defect with fungal pneumonia (Aspergillus sp.). The radiologic appearance of invasive pulmonary aspergillosis can resemble a malignant lung mass. Clinical manifestations of X-linked CGD are severe and present at an earlier age compared with autosomal recessive form. Neonatal presentation of CGD due to NCF1 defect has not previously been reported.

To conclude, CGD must be suspected in neonates presenting with invasive pulmonary fungal infection in the absence of any risk factors. Establishment of genetic diagnosis can aid in prenatal diagnosis of the affected families.

Source: https://journals.lww.com/pidj/Fulltext/2020/12000/A_Neonate_With_Fungal_Lung_Nodules_Mimicking.42.aspx
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Dr. S●●●●●●i N●●●u K●●●●●m
Dr. S●●●●●●i N●●●u K●●●●●m Pulmonary and Critical Care Medicine
Nice case sir
Nov 25, 2020Like