Presentación tomográfica con aspecto miliar en paciente inmunocomprometido con candidiasis pulmonar: reporte de caso

INTRODUCTION Candida albicans infection shows a wide range of patterns on chest computed tomography, including ground glass opacities and consolidation, with the miliary pattern being the least frequent. The miliary pattern is not exclusive to tuberculosis. Fungal lung infections are rare and potentially fatal. Colonization by Candida albicans, associated with impaired immunity, requires early empirical antifungal therapy to improve survival. CASE REPORT 48-year-old male patient with persistent productive cough, mucopurulent expectoration, dyspnea on moderate exertion, night sweats, elevated temperature, and weight loss. Chest tomography revealed miliary interstitial lung disease, and he was prescribed antituberculosis treatment. Diagnostic video bronchoscopy showed two tumors in the right main bronchus. Studies of the samples revealed the presence of Candida albicans in the pulmonary parenchyma. A new contrasted chest tomographic study reported a heterogeneous lesion in the esophagus. The pathologic result of the biopsy concluded the presence of moderately differentiated keratinized infiltrating squamous cell carcinoma. The patient died. DISCUSSION The miliary tomographic pattern requires a broader approach for accurate diagnosis. The reported case presented with oral candidiasis and impaired immunity. Previous colonization associated with impaired immunity is the most important factor found for disseminated candidiasis. CONCLUSION The miliary radiological pattern is not exclusive to tuberculosis, warranting a more precise diagnostic approach. It is important to diagnose disseminated candidiasis in order to initiate early antifungal therapy and thus improve survival.