International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 3, Issue 2 | Case Report | Open Access DOI

The Masked Masquerader - Lung Malignancy Disguised as Fungal Pneumonia

Dr. Nandu Nair*

Aksharaa Benjamin, Nandakishore Baikunje, Chandramouli MT and Nandu Nair*

Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, Karnataka, India

*Correspondence to: Dr. Nandu Nair 

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An elderly male without comorbidities presented with complaints of cough with expectoration for 6 months and breathlessness on exertion for 15 days. He had history of weight loss of 5 kilograms in 6 months. Chest X-Ray (CXR) showed bilateral fluffy opacities with areas of consolidation and diffuse nodules. He underwent treatment at an outside clinic in view of suspected Pneumocystis jirovecii pneumonia (PJP) after which he showed transient improvement but worsened again. He delayed going to a hospital by 3-4 months and presented to our OPD with worsening symptoms. He underwent routine investigations and was started on antibiotics. Fungal pneumonia was suspected and he was started on anti-fungal therapy. Due to non-improvement of general condition, a contrast-enhanced computerised tomography (CECT) thorax was done, which showed “Multiple bilateral diffuse centrilobular and peripheral enhancing patchy opacities and nodular lesions are noted in segmental and lobar distribution. The lesions show air bronchogram and enhancing pulmonary vessels within” which was consistent with infection and a differential diagnosis of fungal pneumonia or malignancy was suspected. A CT-guided fine needle aspiration cytology (FNAC) of the lesion was done which showed ‘non-small cell carcinoma (NSCC) favouring adenosquamous carcinoma’. Patient required further testing in the form of immunohistochemistry (IHC) but was unwilling for the same and requested discharge against medical advice (DAMA). On follow up with the patient party, it was found that the patient expired 8 days following discharge from the hospital.


Lung; Chest


Benjamin A, Baikunje N, Chandramouli MT,Nair N. The Masked Masquerader - Lung Malignancy Disguised as Fungal Pneumonia. Int Clinc Med Case Rep Jour. 2024;3(1):1-10.