Multiple endobronchial mycetomas with varied appearances and mixed fungal flora

We present images of a patient with multiple endobronchial mycetomas visible by bronchoscopy with varying appearances and with mixed fungal flora on culture. A 44-year-old African American male previously treated for pulmonary tuberculosis 11 years earlier presented with moderate hemoptysis and infiltrates in the right upper lobe on chest radiograph. He received levofloxacin without improvement in the infiltrate. Computed tomography scan revealed bronchiectasis, multiple intrabronchial masses, and air crescents. Diagnostic evaluation was negative for acid fast bacilli. Bronchoscopy revealed 4 separate endobronchial masses with varied appearances within dilated bronchiectatic airways. Culture of washings revealed Cunninghamella species, Aspergillus fumigatus, and Penicillium species. The patient underwent a lobectomy and was discharged on an azole antifungal agent, which was discontinued after 6 weeks.