PulmoWorld: An Asynchronous Multimodal Medical World Model for Longitudinal Pneumonia Dynamics

Pneumonia changes across respiration, inflammation, and organ function, while the measurements that describe it arrive at different times and are often incomplete. We introduce PULMOWORLD, a world model for longitudinal pneumonia dynamics that connects asynchronous state estimation, recursive simulation, and evidence-constrained planning. History-aware filtering separates state propagation from observation-driven correction, so clinical, imaging, and bronchoalveolar lavage evidence update a shared belief only when observed. That belief supports recursive forecasts of clinical values and modality representations, and summaries of future prognosis. Cap-MBRL searches imagined continuations inside an authorized action set and replaces a frozen fallback only when a candidate meets the risk budget and a predicted-cost margin. On the pneumonia cohort MASS, recursive forecasts are competitive with task-trained sequence models, and simulated future states retain prognostic information. Trained separately on public MIMIC-IV-CXR chest radiographs and clinical trajectories, this model improves prognostic discrimination over latest-value fusion in development and is competitive on long-horizon error on the locked pneumonia panel. In five known-mechanism MASS-Syn environments, authorized search lowers selection regret relative to direct fallback execution.