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Suggest treatment for fungal infection in lungs

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Posted on Wed, 11 May 2016
Question: Hello doc, a patient's history was chest pain, haemoptysis, & got sometimes fever & been diabetic for 2 years. But on scanning, multiple nodules seen in lungs (approx.4 white grey nodules). Then patient went for truecut biopsy (specimen from one of lungs nodule). The report reveals acute pneumonitis with intra- alveolar and intra- bronchiolar fibrin plugs. No granulomas seen, special stains fail to reveal AFB, fungi or pneumocystitis, no neoplastic lesions seen.
But patient responded to fungal treatment & getting relief. Bcz in sputum examination- candida albicans fungi seen.. now plz suggest me ?
doctor
Answered by Dr. Kaushal Bhavsar (17 minutes later)
Brief Answer:
Get done repeat CT scan.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Since patient is having diabetes, fungal lung infection can occur.
And this can be recurrent.
So at present get done repeat CT thorax to compare with previous scan whether nodules are increasing or decreasing or static.
Can you send me the image of CT thorax?
Bronchoscopy was done or not?
Is patient a smoker?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wishing good health to your patient. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (2 hours later)
plz get the new attached files.
smoking gave up.
and plz suggest me what shoud we do ?
doctor
Answered by Dr. Kaushal Bhavsar (28 minutes later)
Brief Answer:
Don't you have simple CT scan done?

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.. I have gone through the reports you have attached.
It is PET scan. It is not CT scan.
Why you go for PET scan?
Don't you have simple CT scan?
On PET scan, neoplastic lesion and inflammatory lesions look same. And this is more confusing in diabetic patient because PET scan can be false positive in diabetic patient.
Biopsy can be false negative if proper sampling is not done. If lesion was hit in center, only necrotic material will come. So this can not conclude any diagnosis.
So please let me know answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your patient. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar (5 hours later)
1- A patient had been suffering from cancer in throat for 6 months. that was corrected by chemo-radiation therapy. so, that was 2nd scheduled PET CT scan in which only multiple nodules seen in lungs. then doctor suggested for true cut biopsy of suspected lesion in lungs. in report, only fungal infection (Candida albicans) came, then doctor given Rx- As I mentioned in previous question.
* Actually patient has gone 2 times for true cut biopsy, bronchoscopy, chest X-ray, and culture & sensitivity test. ---- so there is no chance of FALSE result.
SO plz tell me, a patient how to get rid from fibrin plug in lungs.
doctor
Answered by Dr. Kaushal Bhavsar (8 hours later)
Brief Answer:
Possibility of lung metastases is more.

Detailed Answer:
Thanks for your follow up question on Health Care Magic.
I can understand your concern.
So patient is known case of throat cancer. Chemotherapy and radiotherapy were given, so patient is mostly having stage 3 or stage 4 throat cancer.
So possibility of lung metastases is more.
In my opinion, you should consider these PET positive spots as metastatic lesions and start treatment accordingly.
Or you should continue with antifungal and antibiotics for 2 months and get done repeat scan to compare the nodules whether increasing or decreasing or static.
If it is increasing then these are metastases.
If it is static or decreasing then infection is more likely.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Kaushal Bhavsar

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Practicing since :2008

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Suggest treatment for fungal infection in lungs

Brief Answer: Get done repeat CT scan. Detailed Answer: Thanks for your question on Health Care Magic. I can understand your concern. Since patient is having diabetes, fungal lung infection can occur. And this can be recurrent. So at present get done repeat CT thorax to compare with previous scan whether nodules are increasing or decreasing or static. Can you send me the image of CT thorax? Bronchoscopy was done or not? Is patient a smoker? Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wishing good health to your patient. Thanks.