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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 …
Contributors MR wrote the article; GP conducted the literature search and prepared the images; OE conceived the idea behind the manuscript, oversaw and contributed to the writing of the manuscript and serves as the guarantor.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.