Rapid Progressive Antibiotic Resistant Pneumonia as a Challenging Case in Remote Area: Is it Antibiotic Resistant Bacteria or Fungal Infection?

Introduction: Pneumonia is an acute inflammation of lung parenchymal due to pathogen infection (bacterial, viral, fungal, and parasitic) but not including specific parenchymal lung inflammation caused by mycobacterium tuberculosis. Fungal pneumonia is a rare disease and difficult to diagnose, this disease could lead to misdiagnosis with antibiotic resistant bacterial pneumonia.Case Presentation: We present a 53 years old woman with comorbid hepatocellular carcinoma and low lymphocyte level who was suspected with fungal pneumonia and bacterial pneumonia as differential diagnosis who failed with adequate antibiotic regimen. We use fluconazole as a drug of choice due to lack of diagnostic tools to identify the causing microorganism, and limited source of medication.Discussion: Fungal pneumonia is a rare disease and difficult to diagnose due to wide range of symptom. Presence of risk factor and inability to treat with antibiotic should be make a suspicion to fungal pneumonia. Radiograph finding of ground-glass opacity could help to make the diagnosis, followed with microbiologic examination. The treatment should be considered causative agent and patient conditions.Conclusion: Antibiotic unresponsive pneumonia with risk factor, clinical and radiologic suggestive finding should be considered as fungal pneumonia as differential diagnosis, adequate treatment and examination including radiographic and microbiology should be performed.