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The case emphasizes that dark, viscous cavity aspirates can signal invasive fungal infection and warrants prompt, targeted antifungal therapy in severe cellular immunodeficiency.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/candida-krusei-lung-abscess-with-black-necrotic-aspirate/444248/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/candida-krusei-lung-abscess-with-black-necrotic-aspirate/444248.png","ImageObject",300,407,{"name":42,"@type":43},"Cart","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What was the patient’s underlying condition and risk factor?","Question",{"text":63,"@type":64},"The patient had newly diagnosed HIV infection with profound cellular immunodeficiency, along with chronic hepatitis B and C coinfection.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What did imaging show in this lung abscess case?",{"text":68,"@type":64},"Chest radiography demonstrated a large cavitary lesion with an air-fluid level in the left lower lobe, and contrast-enhanced CT showed thick-walled abscess cavity with surrounding consolidation plus bilateral ground-glass opacities with tree-in-bud nodules.",{"name":70,"@type":61,"acceptedAnswer":71},"How was the cause of the lung abscess confirmed?",{"text":72,"@type":64},"Ultrasound-guided aspiration yielded black, highly viscous necrotic material, direct microscopy showed budding yeast, and fungal culture identified Candida 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Necrotic Aspirate  \nShan Kai Ing  | Pon Ying Lau | Nga Hung Ngu  \nRespiratory Unit, Department of Medicine, Sibu Hospital, Sibu, Sarawak, Malaysia Correspondence: Shan Kai Ing ([shankai1992@gmail.com](shankai1992@gmail.com))  \nReceived: 12 December 2025 | Accepted: 15 December 2025  \nAssociate Editor: Jennifer Ann Wi  \nKeywords: black aspirate | Candida krusei | lung abscess | opportunistic fungal infection  \nABSTRACT  \nA profoundly immunocompromised man developed a large cavitary lung lesion producing black, viscous aspirate, with culture confirming Candida krusei. This rare manifestation underscores that atypically dark aspirates from lung cavities should raise suspicion for invasive fungal infection and prompt early antifungal therapy in patients with severe cellular immunodeficiency.  \nFIGURE 1 | (A) Chest radiograph demonstrating a large cavity with an air–fluid level in the left lower lobe. (B) Contrast-enhanced CT showing a thick-walled 6 × 8 × 13 cm abscess cavity with surrounding consolidation and bilateral ground-glass opacities. (C) Black, viscous necrotic aspirate obtained from the cavitary lesion; fungal culture yielded Candida krusei.  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.  \nRespirology Case Reports, 2026; 14:e70460 1 of 2  \n[https://doi.org/10.1002/rcr2.70460](https://doi.org/10.1002/rcr2.70460)  \nA 29-year-old man with newly diagnosed HIV infection (CD4 17 cells/μL) and chronic hepatitis B and C coinfection presented with progressive dyspnoea and dry cough shortly after discharge following treatment for Fournier gangrene and multidrugresistant bacterial pneumonia. Chest radiography demonstrated a large cavitary lesion with an air–fluid level in the left lower lobe (Figure 1A) . Contrast-enhanced CT of the thorax revealed diffuse bilateral ground-glass opacities with tree-in-bud nodules and a thick-walled 6 × 8 × 13 cm cavity surrounded by consolidation (Figure 1B). Ultrasound-guided aspiration produced black, highly viscous necrotic material with sediment and surface film (Figure 1C) . Direct microscopy revealed budding yeast cells, and fungal culture identified Candida krusei, an intrinsically fluconazole-resistant species. Invasive C. krusei pulmonary infection is exceptionally rare and occurs mainly in individuals with profound cellular immunodeficiency, but non-albicans Candida species are increasingly implicated in invasive candidiasis with rising antifungal resistance worldwide [1] . The unusual black discoloration of the aspirate likely reflected extensive tissue necrosis and fungal pigment deposition. In immunocompromised patients, cavitary lesions that yield dark or unusually viscous aspirate should prompt evaluation for invasive fungal infection and early targeted antifungal therapy [2] .  \nAuthor Contributions  \nS.K.I. conceived the idea for case reporting and prepared the final manuscript with P.Y.L. and N.H.N. N.H.N. were the managing pulmonologists. All authors reviewed and approved the final version of the manuscript.  \nAcknowledgements  \nThe authors would like to thank the Director General of Health Malaysia for the permission to publish this article.  \nFunding  \nThe authors have nothing to report.  \nConsent  \nThe authors declare that written informed consent was obtained for the publication of this manuscript and accompanying images using the form provided by the Journal.  \nConflicts of Interest  \nThe authors declare no conflicts of interest.  \nData Availability Statement  \nData sharing not applicable to this article as no datasets were generated or analysed during the current study.  \nRefe","cbCaigG7Xtv4jVXf","https://ap.wps.com/l/cbCaigG7Xtv4jVXf","pdf",804868,"English","# Abstract\n# Clinical Presentation and Imaging\n# Diagnostic Findings\n# Author Contributions, Funding, Consent, and Conflicts of Interest\n# Data Availability and References","[{\"question\":\"What was the patient’s underlying condition and risk factor?\",\"answer\":\"The patient had newly diagnosed HIV infection with profound cellular immunodeficiency, along with chronic hepatitis B and C coinfection.\"},{\"question\":\"What did imaging show in this lung abscess case?\",\"answer\":\"Chest radiography demonstrated a large cavitary lesion with an air-fluid level in the left lower lobe, and contrast-enhanced CT showed thick-walled abscess cavity with surrounding consolidation plus bilateral ground-glass opacities with tree-in-bud nodules.\"},{\"question\":\"How was the cause of the lung abscess confirmed?\",\"answer\":\"Ultrasound-guided aspiration yielded black, highly viscous necrotic material, direct microscopy showed budding yeast, and fungal culture identified Candida krusei.\"}]","Candida krusei Lung Abscess With Black Necrotic Aspirate | PDF",1790707322]