Dual Infection of a Pulmonary Hydatid Cyst by Aspergillus fumigatus in a Diabetic Adult: A Case Report From a Tertiary Care Hospital in the United Arab Emirates

Hydatid disease, caused by <i>Echinococcus granulosus</i>, most commonly affects the liver and lungs. Coinfection of a hydatid cyst with fungal organisms such as <i>Aspergillus fumigatus</i> is exceedingly rare, particularly in immunocompetent individuals. The aim of this case report is to describe the clinical course, diagnostic approach, and management of a patient with dual infection of a pulmonary hydatid cyst by <i>A. fumigatus</i>, highlighting its diagnostic challenges and implications for clinical practice. We present a case of a 66-year-old male with type 2 diabetes mellitus, bronchial asthma, and chronic kidney disease, who developed a two-month history of productive cough, intermittent fever, and hemoptysis. Chest imaging revealed a cavitary lesion in the right upper lobe. Initial bronchoscopy and cultures identified <i>Klebsiella pneumoniae</i>, which was treated with intravenous antibiotics. Due to persistent symptoms, a second bronchoscopy revealed fungal hyphae and laminated cystic membranes, suggestive of coexisting aspergilloma and hydatid cyst. Despite treatment with oral voriconazole and albendazole, follow-up imaging demonstrated progression of the lesion. The patient subsequently underwent a right upper and middle lobectomy. Histopathological analysis confirmed dual infection with <i>Echinococcus granulosus</i> and <i>Aspergillus fumigatus</i>. He recovered uneventfully and remained disease-free at a three-year follow-up. Early recognition of rare dual infections, such as a pulmonary hydatid cyst with <i>Aspergillus fumigatus</i> coinfection, is essential for improving outcomes. Clinicians should consider fungal coinfection when chronic pulmonary cavities fail to respond to empirical treatment, especially when bronchoscopy reveals fungal hyphae and laminated membranes. Researchers should further investigate the pathophysiology and optimal treatment strategies for such coinfections, while policymakers should ensure access to advanced diagnostic tools and multidisciplinary surgical care in endemic regions.