Case Report: A Broncho-alveolar Lavage (BAL) sample was received on 12/01/11 from a 17 year old male patient having liver transplant three years ago with clinical details of having pulmonary nodules. Sample was sent to investigate Bacterial, Tuberculosis (TB), Viral and Fungal pathogen. Sample was found to be negative for TB and Viral. Dematiaceous mold Cladophialophora bopii was isolated in Mycology section and was reported on 17/01/2011. But the BAL sample sent to Histopathology was reported as negative for fungal element. It was decided not to start antifungal therapy because no convincing data was available. In May 2011, lung tissue (biopsy) was received with clinical details as: Liver Transplant, brain enhancing lesion with cavitary lung nodules and thickening of Jujeanal wall to rule out TB vs. Lymphoma. This time also sample was found to be negative for TB. Fungal microscopy showed septate mycelium in KOH which was further verified by Silver, PAS and H&E stains. Heavy growth of Cladophialophora bopii was found in culture and reported. This time sample sent to Histopathology was also reported positive for fungal elements. MRI and X-Ray reports also indicated the fungal infection. The patient was started on antifungal therapy with AmphotericinB and later on replaced with Posaconazole but unfortunately the patient passed away. To our knowledge this is the first case of C. bopii causing brain and lung infection in Saudi Arabia.
This case serves as an alert, especially in the case of immune-compromised patients, as soon as there is any sign available about the fungal infection whether it is clinical, radiological, biochemical, histological or microbiological, the antifungal therapy should be started as pre-emptive strike because any delay in therapy may lead to a fatal outcome.
Full conference title:
- ASM 113th (2013)