Cavitating lung cancer with underlying lung fibrosis treated as case of post-COVID-19 lung fibrosis with invasive mucormycosis

Abstract

The pulmonary cavity is caused by infective, inflammatory, and malignant lung pathologies. In the currently ongoing COVID-19 pandemic, the most common cause for pulmonary cavities would be tuberculosis and fungal infections in the presence of exposure of high-dose steroids given during the course of hospitalization for COVID-19 pneumonia. In the present case report, an 86-year-old male presented with cavitating lung mass with hemoptysis who had received high-dose steroids for acute hypoxic respiratory failure due to COVID-19 pneumonia. He was treated with high-dose steroids during and after hospitalization for post-COVID-19 lung fibrosis with oxygen dependency and continuous oxygen supplementation. The right upper lobe mass was underevaluated, and developed cavitating consolidation in 3 months. He was evaluated and treated as a case of right upper lobe invasive aspergillosis and mucormycosis infection documented on sputum culture. He was treated with amphotericin B and higher antibiotics and discharged with oral voriconazole. Intermittent hemoptysis was a clinical clue to workup further with bronchoscopy for protocolized diagnosis of cavitating lung mass. Bronchoscopy documented moderately to poorly differentiated squamous cell carcinoma as a cause for cavitating consolidation. A high index of suspicion is must while dealing with pulmonary cavities. The currently ongoing COVID-19 pandemic may result in an underestimation of malignancy as a cause for cavitating lung pathology due to the rampant use of steroids during treatment of these cases and more documentation of fungal lung infections in post-COVID-19 care settings. We recommend bronchoscopy in cavitating lung disease for exact 'etiopathology documentation' of tropical and or malignant lung disease.