Curvularia species of fungi are ubiquitous and mostly comprise plant or soil residents. Rarely pathogens, they are found in tropical and subtropical climates. On rare occasions, these fungi can be of clinical significance and lead to a variety of disease processes, mainly in immunocompromised individuals. Most infections are limited to allergic fungal rhinosinusitis; however, disseminated disease and invasive infections have been increasingly reported. There exist no therapeutic guidelines for invasive Curvularia infections currently, but amphotericin and various azoles have been used with varying degrees of success. We present a unique case of an immunocompetent 44-year-old female who presented with symptoms concerning for pneumonia and was found to have a mass-like lesion in the lung concerning for malignancy. Biopsy and histopathology of the lesion were consistent with invasive Curvularia pulmonary infection. We reviewed this case in the setting of reported literature concerning Curvularia with an emphasis on the epidemiology, pathology, diagnosis, and emerging management protocols of invasive Curvularia infections.
Patients with serious or life-threatening illnesses are typically referred to palliative care to discuss goals of care, advance care planning, and to seek control of their cancer-related pain. Physicians who care for patients near the end of life quite often attribute worsening pain to advancing disease. We present a case of a patient with metastatic gallbladder adenocarcinoma who presented to a palliative care clinic with complaints of worsening chest and back pain, uncontrolled with her established opioid pain regimen. Findings on physical examination prompted the search for other etiologies of this patient's worsening pain. An initial review of her recent investigations revealed a suspicious positron emission tomography (PET) scan obtained prior to her clinic appointment, which showed a large right-sided pneumothorax with tension physiology. The patient was urgently sent to the emergency room for emergent placement of a chest tube. This case attempts to bring awareness to the potential bias physicians may have regarding the pain experienced by patients with advanced disease and who are near the end of life. The performance of a thorough physical examination can be neglected in a developed, resource-rich country where imaging is easily accessible. Although the adoption of a stepwise ladder in pain management for patients at the end of life is frequently implemented, forgoing a thorough history and physical examination can have detrimental effects. Consideration of other etiologies of acute pain remains imperative when treating patients at the end of life.
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