Delayed fatal pulmonary artery pseudoaneurysm following dual invasive pulmonary fungal infection- a case report

Abstract Background Concurrent invasive pulmonary mucormycosis and aspergillosis is an exceptionally rare and life-threatening dual mould infection. Both pathogens exhibit angioinvasive behaviour and may cause severe vascular complications, including pulmonary artery pseudoaneurysm, which can result in fatal massive hemoptysis. Case presentation We report the case of a 60-year-old man with newly diagnosed type 2 diabetes mellitus who presented with fever, productive cough, and progressive breathlessness. Computed tomography (CT) of the thorax revealed bilateral consolidations with a reverse halo sign and areas of necrosis, suggestive of angioinvasive fungal pneumonia. Bronchoalveolar lavage and transbronchial lung biopsy established the diagnosis of concurrent invasive pulmonary mucormycosis and aspergillosis. The patient was treated with intravenous liposomal amphotericin B followed by oral posaconazole, resulting in marked clinical improvement. However, six weeks after initiation of antifungal therapy, he developed recurrent hemoptysis. Computed tomography pulmonary and bronchial angiography demonstrated a left pulmonary artery pseudoaneurysm. Although urgent endovascular embolization was planned, the aneurysm ruptured before intervention, resulting in catastrophic massive hemoptysis and death. Conclusion This case highlights that delayed pulmonary artery pseudoaneurysm may occur despite apparent clinical improvement in dual invasive pulmonary fungal infection. Recurrent hemoptysis during follow-up should prompt urgent vascular imaging to facilitate early diagnosis and potentially life-saving intervention.