title: A necrotic lung ball caused by co-infection with Candida and Streptococcus pneumoniae.
abstract: BACKGROUND
  A necrotic lung ball is a rare radiological feature that is sometimes seen in cases of pulmonary aspergillosis. This paper reports a rare occurrence of a necrotic lung ball in a young male caused by Candida and Streptococcus pneumoniae.
  
  
  METHODS
  A 28-year-old male with pulmonary candidiasis was found to have a lung ball on computed tomography (CT) of the chest. The patient was treated with β-lactams and itraconazole and then fluconazole, which improved his condition (as found on a following chest CT scan) and serum β-D-glucan level. The necrotic lung ball was suspected to have been caused by coinfection with Candida and S. pneumoniae.
  
  
  CONCLUSIONS
  A necrotic lung ball can result from infection by Candida and/or S. pneumoniae, indicating that physicians should be aware that patients may still have a fungal infection of the lungs that could result in a lung ball, even when they do not have either Aspergillus antibodies or antigens.
authors.affiliation: Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Jun
authors.initials: J
authors.lastname: Sasaki
authors.forename: Keita
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Chie
authors.initials: C
authors.lastname: Koga
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ito
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kaku
authors.forename: Morihiro
authors.initials: M
authors.lastname: Tajiri
authors.forename: Hiroki
authors.initials: H
authors.lastname: Natori
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirokawa