Opportunistic fungal pneumonias in cancer patients.

The chest radiographic abnormalities in 92 patients with autopsy proven fungal pneumonias (Candida, 50 patients; Aspergillus, 35 patients; Mucoraceae, four patients; Cryptococcus, two patients; and Histoplasma, one patient) in immunosuppressed cancer patients were reviewed, Aspergillus and Mucoraceae most commonly produced solitary or multiple regions of rounded pneumonia that slowly increased in size and/or number and ultimately produced hemorrhagic pulmonary infarctions. Candida most commonly produced a radiographically nonspecific bronchopneumonia. Any of the fungi may produce a miliary-nodular pattern on the chest radiograph. The miliary-nodular pattern was more frequently seen with Candida. All of these radiographic patterns are nonspecific and may be mimicked by other pathologic processes. However, when placed in the proper clinical setting, the findings become much more specific. They tend to develop at the nadir of the patients' chemotherapeutic induced leukopenia and occur most commonly in patients with hematologic malignancies who have received extensive broad-spectrum antibiotics.