Scopulariopsis brevicaulis: A Case of Mistaken Takayasu Arteritis

T. B. Walls, R. F. Relich, T. E. Davis, B. H. Schmitt

Author address: 

Indiana Univ. Sch. of Med., Indianapolis, IN

Abstract: 

Background: Scopulariopsis brevicaulis, a hyaline mold, is generally associated with onychomycosis, but in rare instances, it can cause deep tissue infections, otomycosis, and infections of the brain, lungs, and bone. This report describes a case of Scopulariopsis endocarditis secondary to iatrogenic immunosuppression. Case: A 37-year-old Japanese woman with a past medical history of aortic valve replacement secondary to a congenital aortic aneurysm and presumed Takayasu arteritis treated with prednisone presented to the hospital with left-sided back and lower abdominal pain. The patient had a 9-month recent history of repeated emboli with fevers. A CTA of the chest was obtained and showed a moderately-sized pseudoaneurysm from the ascending aortic graft and filling defects concerning for thrombi in the distal ascending aorta/proximal aortic arch near the graph anastomosis. Portions of thrombus from the thrombectomy were sent for histopathology and culture. Results: Histopathologic examination of the left iliac artery thrombus revealed branching, septate hyphae; however, blood cultures were negative. Subsequently, voriconazole was added to the patient’s empiric antimicrobial regimen to cover suspected aspergillosis. The diagnosis of Takayasu arteritis was dismissed as the etiology of the patient’s aneurysm and the patient’s regimen of prednisone was discontinued. Fungal cultures of the tissue grew S. brevicaulis and amphotericin B was added to the antifungal regimen pending susceptibility data. Discussion: The isolate was later determined to be susceptible to posaconazole and micafungin, which prompted treatment with these drugs exclusively. After a 78-day hospital stay, the patient was discharged on long-term antifungal therapy with posaconazole. Scopulariopsis species are a rare cause of infective endocarditis. Less than 50% of cases of fungal endocarditis yield positive blood cultures, rendering this diagnostic method suboptimal. A combination of culture and histopathology are necessary to effectively detect this organism, and susceptibility testing of isolates is necessary to optimize therapy.
2016

abstract No: 

SATURDAY-308

Full conference title: 

ASM Microbe 2016
    • ASM microbe 1st (2016)