Massive hemoptysis due to a candida-related pulmonary artery pseudoaneurysm

Excerpt

A 34-year-old woman was admitted to our intensive care unit for massive hemoptysis after having received chemotherapy for a metastatic trophoblastic gestational tumor. A Candida albicans catheter-related bloodstream infection had been diagnosed within the preceding 3 months. After removal of the endovascular device, she received long-term caspofungin and anticoagulant therapy because of a right atrial thrombus and pulmonary thromboembolisms of right middle and lower lobes. Following admission for hemoptysis, thoracic CT-scan (Fig. 1a) disclosed a partially thrombosed pulmonary artery pseudoaneurysm with extravasation of iodinated contrast media. Transcatheter embolotherapy of the pseudoaneurysm was immediately performed (Fig. 1b), using more than 3 m of coils (Fig. 1c), achieving an immediate bleeding control. Direct examination of tracheal aspirate disclosed yeasts but culture was negative, and serum 1,3-beta-glucan exceeded 500 pg/mL (normal level < 6.0 pg/mL). A right pneumonectomy was performed 5 days later, considering the high risk of bleeding recurrence. Lung pathology demonstrated a pseudoaneurysm of the right pulmonary artery, with an altered elastic layer of the parietal wall and a hemorrhagic mycetoma within lumen (Fig. 2a, b). Grocott stain revealed pseudohyphae and yeasts within mycetoma (Fig. 2c). Here is reported the first case of Candida-related pulmonary artery pseudoaneurysm illustrated with radiological, histopathological and mycological pictures.

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