Predisposing conditions:
(1) AIDS
(2) exogenous immunosuppression
(3) hereditary immunodeficiency
(4) chronic granulomatous disease (CGD)
If a "normal" patient presents with fulminant fungal pneumonia then chronic granulomatous disease should be suspected.
Requirement: sudden exposure to aerosolized saprophytic, filamentous fungi such as an Aspergillus species. This may occur after spreading mulch, handling hay, raking leaves or entering a moldy environment.
Interval between exposure and onset of symptoms: 1-10 days
Clinical features:
(1) fever, cough and flu-like symptoms
(2) dyspnea, which is often progressive
(3) rapid spread of a pulmonary infiltrate which quickly becomes bilateral
(4) severe hypoxemia
(5) catastrophic course and may be fatal if not treated aggressively
Differential diagnosis:
(1) hypersensitivity pneumonitis
(2) allergic bronchopulmonary aspergillosis
(3) deep fungal pneumonia (histoplasmosis, cryptococcosis, etc)
(4) bacterial pneumonia
