A fatal invasive Scedosporium apiospermum pulmonary infection in an adult patient with malignant lung adenocarcinoma

Abstract

Background and purpose: Scedosporium apiospermum complex as a ubiquitous environmental mold is increasingly reported to cause an invasive fungal infection in immunosuppressive hosts. Herein, we present the case of an immunosuppressive 54 - year-old man who developed S. apiospermum complex lung infection and pulmonary adenocarcinoma.

Case report: The patient had some complaints of dyspnea and cough during a neutropenic episode. The computed tomography (CT) scan of the patient revealed pleural effusion. After culturing the pleural fluid sample, the fungus was identified by microscopic examination and ITS sequencing. In addition, antifungal susceptibility testing was performed using the M38-A2 microdilution method. The minimum inhibitory concentrations of amphotericin B, voriconazole, posaconazole, and caspofungin were obtained as > 64, 0.06, 0.06, and 0.03 µg/mL, respectively. Voriconazole (administered in two doses of 6 mg/kg and a maximum of 250 mg) was preferred for treatment. The patient received antifungal treatment for 2 months; however, he was lost to follow-up.

Conclusion: Scedosporium apiospermum complex should be considered a cause of systemic fungal infections in neutropenic patients. Furthermore, the determination of the in vitro antifungal susceptibilities of clinical strains may contribute to the development of therapeutic approaches.

Keywords: İnvasive fungal disease; Febrile neutropenia; Scedosporium apiospermum.

Figure 1

Presence of a mass lesion a year ago in the left lung lobe

Figure 2

Presence of a mass lesion in the left lung lobe

Figure 3

Colony of Scedosporium apiospermum complex on Sabouraud dextrose agar medium (The colony appearance is cottony and velvety, with the color being changed from white to grey.)

Figure 4

Microscopic examination of the slide culture stained with lactophenol cotton blue staining and branching septated hyphae and ovale sesile conidia