Oropharyngeal candidiasis in a patient with COPD and risk of aspiration pneumonia

Abstract

Introduction: Oropharyngeal candidiasis (thrush) is a frequent opportunistic infection in elderly patients with chronic respiratory comorbidities and predisposing factors such as long-term smoking, chronic obstructive pulmonary disease (COPD), and impaired airway protective reflexes.  Clinical case: We report the case of an 86-year-old male farmer, with a history of hypertension, benign prostatic hyperplasia, and COPD on bronchodilator therapy, who presented with progressive dyspnea, productive cough, and chest tightness after recent hospital discharge due to COPD exacerbation. Clinical evaluation revealed whitish oral mucosal lesions consistent with oropharyngeal candidiasis, as well as concomitant colonization by Acinetobacter baumannii complex sensitive to imipenem. Treatment with fluconazole and targeted antibiotic therapy was initiated, with favorable clinical outcome. Discussion: This case highlights the importance of clinical suspicion of opportunistic infections in elderly patients with COPD and the need for multidisciplinary surveillance to prevent associated complications such as aspiration pneumonia.