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Lung India Official publication of Indian Chest Society  
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  Table of Contents    
Year : 2019  |  Volume : 36  |  Issue : 6  |  Page : 558-559  

A young male with hemoptysis

Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication31-Oct-2019

Correspondence Address:
Dr. Saurabh Mittal
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/lungindia.lungindia_165_19

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How to cite this article:
Mittal S, Madan K, Mohan A, Hadda V. A young male with hemoptysis. Lung India 2019;36:558-9

How to cite this URL:
Mittal S, Madan K, Mohan A, Hadda V. A young male with hemoptysis. Lung India [serial online] 2019 [cited 2020 Feb 19];36:558-9. Available from: http://www.lungindia.com/text.asp?2019/36/6/558/270076

A 33-year-old male presented with complaints of dry cough for the last 5 years associated with streaky hemoptysis. There was no history of associated fever, loss of weight, or loss of appetite. He was diagnosed as type 1 diabetes mellitus at the age of 12 years and had been on insulin therapy for the same with good glycemic control (HbA1c 7.2%). There was no occupational exposure, and he was a never smoker. On examination, he was well built and vitals were stable. Rest of the general physical and systemic examination was unremarkable. Computed tomography (CT) thorax was done [Figure 1]a, and based on the findings, he was started on antitubercular therapy. There was no symptomatic improvement, and he had received treatment for multidrug-resistant tuberculosis. Due to persistent symptoms, a diagnostic flexible bronchoscopy was performed at our center which demonstrated a yellow-black plug in the right lower lobe anterior segment [Figure 1]b and biopsy was obtained.
Figure 1: (a) Computed tomographic thorax demonstrating cavitary lesion in the right lower lobe, (b) bronchoscopic appearance of plug occluding the lower lobe segment

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   Question Top

What is this CT sign known as and what is the diagnosis?

   Answer Top

Bird-nest sign suggestive of pulmonary mucormycosis.

Mucormycosis is a fungal infection caused by fungi of Zygomycetes family. It commonly affects immunosuppressed individuals including diabetics although it is reported in an immunocompetent host as well.[1] The radiological feature suggesting invasive fungal infection in an appropriate clinical setting is the presence of ground-glass opacity surrounded by an area of consolidation, known as reverse halo sign. The area within ground-glass opacity may have irregular and intersecting areas of stranding which is known as bird-nest sign.[2] In a neutropenic patient, this sign is considered suggestive of invasive mucormycosis more than aspergillosis. The histopathological specimen demonstrated broad aseptate hyphae consistent with mucormycosis. The patient was started on liposomal amphotericin B therapy and underwent right lower lobe segmentectomy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Lin E, Moua T, Limper AH. Pulmonary mucormycosis: Clinical features and outcomes. Infection 2017;45:443-8.  Back to cited text no. 1
Jung J, Kim MY, Lee HJ, Park YS, Lee SO, Choi SH, et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect 2015;21:684.e11-8.  Back to cited text no. 2


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