Abstract

We present the case of a sixty-one-year-old male with chronic kidney disease (CKD) who developed multi-organ dysfunction characterised by tracheobronchial aspergillosis, hepatocellular carcinoma (HCC), urosepsis, and acute kidney injury (AKI).1,2 The patient initially presented with respiratory distress, haematuria, and sepsis, requiring intensive multidisciplinary intervention. Radiological investigations revealed a fluorodeoxyglucose (FDG)-avid hepatic lesion with features suggestive of HCC3 and widespread bronchial pseudomembranes consistent with invasive aspergillosis.4 Management involved haemodialysis, antifungal therapy, bladder clot evacuation, and supportive care.5 This case underscores the complexity of managing critically ill patients with overlapping infectious and oncological pathologies presenting to emergency services.1,6 Early identification and coordinated multidisciplinary care are critical for optimising outcomes.7 Furthermore, the coexistence of severe fungal airway disease with advanced hepatic malignancy and septic complications highlights the need for heightened clinical vigilance in high-risk CKD populations.8 The integration of serial bronchoscopic assessments, targeted antifungal therapy, and vigilant organ support played a pivotal role in stabilising this patient, demonstrating the importance of comprehensive emergency and critical care pathways in managing such rare and life-threatening presentations.9,10 Key Messages: This case highlights the diagnostic and therapeutic challenges posed by the coexistence of tracheobronchial aspergillosis and hepatocellular carcinoma in a patient with chronic kidney disease and sepsis. Prompt multidisciplinary management is essential to improve survival outcomes in such critically ill patients.

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