Introduction: Invasive infection by Scedosporium apiospermum, a common soil fungus with an ubiquitary distribution, have been largely reported in immunosuppressed patients (haematological malignancy, organ transplantation, AIDS, steroids treatments). Scientific literature reports only few description of invasive infections of the immunocompetent host. In this report, we describe a case of S. apiospermum invasive lung infection with histological confirmation in a immunocompetent patient. Case report: A 68-year-old man was admitted in our Department complaining of dyspnoea, haemoptysis, weight loss, asthenia and anorexia of 6 months' duration. He also reported night sweat and pyrexia. On admission, his physical examination showed cachexia, hyperpyrexia and purulent sputum. He had an inflammatory anaemia and biological inflammatory syndrome without leucocytosis. The patient had history of lung tuberculosis 40 years before. Chest X-ray and computed tomography (CT) showed a huge cavity with declivous necrotic material affecting the upper right lobe. Bronchoscopy evidenced bronchial distortion (tuberculosis' sequelae). M. tuberculosis and non-specific bacteria did not grow from any specimens of bronchial washing and sputum and no malignant cells were found. Mantoux test and Aspergillus spp. serology and antigenemia were negative. A three-week culture of sputum and bronchial washing grew S. apiospermum; serology was strongly positive. An antifungal treatment with voriconazole was started, but one month later, in reason of no amelioration on CT control and persistence of fever and weight loss, a surgical approach was decided. He underwent an upper and medium lobectomy of the right lung. Subsequent nosocomial pneumonia with respiratory failure caused patient's death few days later. Histology of surgical specimen confirmed S. apiospermum infection. Discussion: Invasive pseudoallescheriasis of the immunocompetent host is poorly reported in literature. This case report highlights importance of differential diagnosis in infection of pre-existing lung cavities in immunocompetent patients, including tuberculosis, common bacterial infections, Aspergillus spp., mycetoma and rare fungal infection like Scedosporium spp., for which a delayed diagnosis potentially worsen prognosis. Indications of an early medical and surgical treatment needs to be defined, such as value of antifungal associations (ex. voriconazole and terbinafine).
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)