SHM Converge Scientific Abstract ePoster Gallery-Hemoptysis and Human Immunodeficiency Virus: A Fungal Surprise

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This case report describes a 57-year-old man with well-controlled HIV on antiretroviral therapy who presented with several days of mild hemoptysis. He had an undetectable viral load and a preserved CD4 count (783 cells/mm³), along with a history of coronary artery disease, diabetes, hypertension, and alcohol use disorder. He was afebrile and had no chest pain or shortness of breath. Initial laboratory testing was unremarkable, and tuberculosis testing was negative.<br /><br />Chest CT showed multiple mycetomas in the right middle lobe with surrounding ground-glass opacities and consolidation, concerning for localized hemorrhage. Because of the imaging findings and recurrent bleeding risk, he underwent robotic-assisted video-assisted thoracoscopic surgery (VATS) with right middle lobectomy and mediastinal lymph node dissection. Pathology revealed fungal debris within bronchiectatic lung tissue with acute and chronic inflammation; no acid-fast bacilli were seen. Fungal culture grew Scedosporium species, confirming a pulmonary mycetoma. Bacterial and mycobacterial cultures were negative.<br /><br />He was treated with voriconazole. Because voriconazole interacts with efavirenz-based antiretroviral therapy, his HIV regimen was changed to bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy). Follow-up imaging showed improvement, and the patient recovered well.<br /><br />The authors emphasize that pulmonary mycetomas are usually seen in immunocompetent patients with preexisting cavitary lung disease, but they can also occur in HIV patients even when immune function is preserved. This case highlights that structural lung disease, rather than immune suppression alone, may predispose to fungal colonization. It also underscores the importance of considering fungal infection in HIV patients with hemoptysis and managing drug interactions carefully during antifungal treatment.

Asset Subtitle

Fardil Khan

Meta Tag

Author List Bruce E. Hirsch, Fardil Khan, Vlad S. Shusterman

Category Clinical Vignettes

Concept Pulmonary Mycetoma

Concept Drug-Drug Interaction

Concept Hemoptysis

Concept Structural Lung Disease

Concept Voriconazole

Distinguished Non-Finalist

Presenter Organization Binghamton University

Presenting Author Fardil Khan

Track Adult

Keywords

pulmonary mycetoma

hemoptysis

HIV

Scedosporium

voriconazole

robotic-assisted VATS

right middle lobectomy

bronchiectatic lung disease

fungal infection

antiretroviral therapy

Pulmonary Mycetoma

Drug-Drug Interaction

Hemoptysis

Structural Lung Disease

Voriconazole