Optimized Physiotherapy Management for Enhancing Respiratory and Physical Functions in a Complex Case of Fungal Pneumonia, Systemic Lupus Erythematosus, Lupus Nephritis, and Acute Kidney Injury: A Case Report

Introduction: Fungal pneumonia is a lung infection caused by endemic or opportunistic fungi. It is common in immunocompromised hosts with systemic lupus erythematosus (SLE) due to immunosuppressive agents and high doses of glucocorticoid treatment. Case Description and Method: We report a case of a 14-year-old female with complaints of coughing, breathlessness, pedal edema, vomiting, and diarrhea. Initial diagnoses were SLE, lupus nephritis (LN), and acute kidney injury (AKI). She was intubated due to not maintaining oxygen saturation. A Chest X-ray showed consolidation and mild pleural effusion. Diagnosis of fungal pneumonia was confirmed by bronchoalveolar lavage. Adventitious sounds, reduced air entry in different areas of the lungs, and reduced chest expansion were found. Chest physiotherapy and passive limb exercises were given. After extubation, other examinations included modified Medical Research Council (mMRC: grade 4), borg scale (15) during limb movements, Cough Symptom Score (CSS: 4) and Functional Status Score for Intensive Care Unit (FSS-ICU: 8) was noted. 6 MWT (220 meters) was taken after the patient shifted to the ward. Respiratory physiotherapy with early mobilization and aerobic exercises were applied. Results: Chest X-ray, chest expansion, mMRC (grade 1), borg scale (9) during limb movements, CSS (2), incentive spirometer (1200 cc/sec), FSS-ICU (35/35), and 6 MWT (310 meters) were improved after physiotherapy interventions. Conclusion: Tailored physiotherapy inputs improve the pulmonary and physical functions of patient with fungal pneumonia, systemic lupus erythematosus, lupus nephritis, and acute kidney injury. Keywords: physiotherapy, fungal pneumonia, respiratory, physical function, systemic lupus erythematosus, acute kidney injury