Mr. Tinh, who smoked for over 50 years but quit about eight months ago, did not have chronic obstructive pulmonary disease (COPD) or tuberculosis. Doctor Tran Minh Giang from the General Internal Medicine unit at Tam Anh General Clinic, District 7, stated that the patient suffered from bilateral pleural effusion, preventing the lungs from expanding normally during breathing.

Mr. Tinh's lung CT scan shows pleural effusion (right side) and collapsed lung parenchyma. *Photo: Tam Anh General Hospital*

Mr. Tinh was transferred to Tam Anh General Hospital, Ho Chi Minh City, for pleural fluid drainage to allow the lungs more space to expand and reduce shortness of breath. Blood tests revealed elevated inflammatory markers, indicating an inflammatory and infectious response in the body.

After two weeks, Mr. Tinh's shortness of breath subsided, and pleural fluid volume decreased, but the treatment response was not yet distinct. Doctor Giang increased the antibiotic dosage and added antifungal medication, suspecting a fungal infection due to environmental factors, as the patient lived in an agricultural area with many warehouses. Subsequently, the patient responded well to treatment; pleural fluid significantly decreased, and cough and shortness of breath symptoms lessened.

Test results identified Aspergillus fungus as the causative agent. This common mold thrives in natural environments, often found in air, dust, soil, decaying straw, and long-stored grains. Depending on the type of infection, Aspergillus can cause respiratory failure due to severe lung bleeding or systemic infection. The most severe complication is infection spreading to other body parts like the brain, heart, and kidneys.

Doctor Giang consults with the patient during a follow-up visit. *Photo: Tam Anh General Hospital*

After six weeks of combined antibiotic and antifungal treatment, the patient's lungs ventilated well, and pleural effusion resolved.

According to Doctor Giang, fungal lung infections are often difficult to detect in early stages because the disease progresses subtly, and clinical symptoms are easily mistaken for pneumonia. Individuals with underlying conditions like COPD, bronchiectasis, or a history of pulmonary tuberculosis should proactively prevent infection by wearing masks when working in dusty or moldy environments. Patients should not self-medicate with antibiotics or corticosteroids without a doctor's prescription. If experiencing prolonged cough, shortness of breath, unexplained fever, or if conventional pneumonia treatment is ineffective, patients should seek examination at a reputable medical facility.

Nhat Thanh

*Patient's name has been changed