Case 224

Case 224


Male 63 years old kidney transplanted patient admitted with fever and productive, persistent cough for about a month, despite appropriate empiric treatment with levofloxacin. Were found during examination: light rhonchi at the right base and bibasilar crackles on auscultation. SpO2 = 88 % with nasal catheter to 4L / min. Were requested radiograph, computed tomography, and bronchoscopy with bronchoalveolar lavage (BAL), which presented the following result : negative search for acid-fast bacilli, bacteria not seen in Gram and culture for fungi in progress. Positive serum galactomannan.

Image 1: Chest radiograph, posteroanterior view.


Image 2: Computed tomography ( CT) scan of the chest without contrast, at the level of the trachea. Pulmonary window.

Considering the clinical history and images, which is the most likely diagnosis?