The Effective Treatment of Lung Infection Due to Scedosporium prolificans with Voriconazole and Surgery

Abstract

Scedosporium prolificans is a fungus that has demonstrated resistance against most currently available antifungal agents and which causes a rapidly disseminating and potentially fatal infection. A 68-year-old woman presented with a fever and consolidation in the lung field. Her symptoms and inflammatory reaction did not improve despite treatment with tazobactam/piperacillin, meropenem, and micafungin. Scedosporium prolificans was detected from the patient's bronchial lavage fluid, and we initiated treatment with voriconazole. Voriconazole was effective in shrinking the consolidation and suppressing the inflammatory reaction. The residual lesion was surgically resected because of the risk of systemic dissemination. The patient is currently alive without relapse or dissemination.

Keywords: Scedosporium prolificans; lung infection; surgery; voriconazole.

Figure 1.

Chest computed tomography scan taken 2 months before admission, showing consolidation of the right lower lung lobe with a high-density area.

Figure 2.

Chest radiograph (A) and computed tomography scan (B) taken on hospitalization, showing enlargement of lung consolidation with a high-density area and bronchiectasis.

Figure 3.

Clinical course. BT: body temperature, CRP: C-reactive protein, div: intravenous drip, MCFG: micafungin, MEPM: meropenem, PIPC: piperacillin, po: per os, TAZ: tazobactam, VRCZ: voriconazole, WBC: white blood cell

Figure 4.

(A) Light microscopic image of a bronchial lavage fluid culture, showing branching hyphae and conidia of Scedosporium prolificans (lactophenol cotton blue stain). (B) Magnified image of (A).

Figure 5.

Chest computed tomography scan taken 3 months after initiation of voriconazole, showing decreased lung consolidation but a residual lesion.

Figure 6.

Light microscopic images of a histopathologic specimen, showing a fungus-like substance in the bronchus. Inflammatory cell infiltration and collagen fiber hyperplasia is noted, but invasion of fungus-like substance into the lung tissue is not definitive. (A) Hematoxylin and Eosin staining. (B) Grocott methenamine silver stain.