Rasmussen Aneurysm and Fungal Co-infection in a Healthy Young Adult With Tuberculosis

A 24-year-old British Indian male experienced a severe and complex course of cavitating pneumonia caused by a rare co-infection with Staphylococcus aureus, Mycobacterium tuberculosis, and a non-albicans Candida species. He initially presented with symptoms of community-acquired pneumonia and was treated with antibiotics and subsequently discharged. Four days later, he re-presented with hemoptysis, hypoxia, and sepsis, requiring intensive care admission. Imaging revealed extensive cavitating lesions in the right lower lobe, empyema, pneumothorax, and a Rasmussen aneurysm. Management included 24 h in the intensive care unit, multiple chest drains, embolization of the aneurysm, and a three-month course of combined antibiotic, antifungal, and antituberculous therapy. Comprehensive immunological workup, including HIV testing, was negative, confirming the patient's immunocompetent status. This case highlights the extreme rarity of such a multifaceted pulmonary co-infection in a young, otherwise healthy individual, and underscores the importance of early identification and aggressive management of concurrent infections and rare but life-threatening complications such as Rasmussen aneurysm and invasive fungal co-infection.