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Behind the (bilateral) fungus ball
  1. Oleg Epelbaum1,
  2. Mahsan Rashidfarokhi2,
  3. Geminikumar Patel3
  1. 1Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
  2. 2Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York, USA
  3. 3Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York, USA
  1. Correspondence to Oleg Epelbaum, Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion Pulmonary Lab, Valhalla, NY 10595, USA; openoleg.epelbaum{at}wmchealth.org

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A 54-year-old man with AIDS and a history of Pneumocystis jirovecii pneumonia presented with chronic cough and weight loss for 1 year. There was no haemoptysis. He had normal vital signs and was afebrile. Lung auscultation was normal. Laboratory evaluation was unremarkable. Chest radiography revealed bilateral upper lobe cavities with internal densities (figure 1). CT of the chest demonstrated these apical cavities to contain material consistent with a mycetoma (fungus ball). Adjacent pleural thickening and areas of consolidation and fibrosis were also present (figure 2). A CT scan performed 2 years previously showed normal lung parenchyma. Sputum fungal culture subsequently grew Aspergillus fumigatus. No antifungal therapy was administered, and the patient was eventually lost to …

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