Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France

Abstract

Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.

Keywords: France; Lomentospora; Lomentospora prolificans; Scedosporium; aortitis; arteritis; fungi; lomentosporiosis; mycotic aneurysm; scedosporiosis; vascular infections.

Figure 1

Abdominal computed tomography scan for case-patient 1 showing arteritis in study of unexpected vascular locations of Scedosporium spp. and Lomentospora prolificans fungal infections, France. Arrow indicates primitive left iliac artery thrombosis and perivascular soft tissue contrast. Data are from the Scedosporiosis/lomentosporiosis Observational Study (12).

Figure 2

Imaging of pulmonary arteritis and abdominal aortitis for case-patients 2 and 3 in study of unexpected vascular locations of Scedosporium spp. and Lomentospora prolificans fungal infections, France. A) Thoracic computed tomography scan for case-patient 2. Arrows indicate left pulmonary artery and right lobar pulmonary artery mycotic aneurysms. B) Hematoxylin-eosin-saffron stain of lung tissue from postmortem analysis of case-patient 2. Triangle indicates bronchial artery wall; star indicates bronchial artery thrombus consisting of radially-disposed multiple septate hyphae. Scale bar indicates 250 μm. C, D) Positron emission tomography-computed tomography scans of case-patient 3. C) Arrow indicates intense abdominal aorta hypermetabolism. D) Arrow indicates abdominal aorta and primitive iliac artery hypermetabolisms. Data are from the Scedosporiosis/lomentosporiosis Observational Study (12).

Figure 3

Radiologic and histopathologic analysis of arteritis in case-patient 4 in study of unexpected vascular locations of Scedosporium spp. and Lomentospora prolificans fungal infections, France. A, B) Pelvic magnetic resonance imaging with T1 gadolinium contrast showing femoral arteritis. A) Arrow shows aneurysms involving the left common femoral artery with posterior mural thrombus. B) Arrow shows left common femoral artery bifurcation. C, D) Grocott-Gomori methenamine silver stain of femoral artery section. C) Star indicates septate fungal hyphae invading the iliofemoral artery tunica media. Original magnification ×100. D) Star indicates septate fungal hyphae invading the iliofemoral artery tunica media. Original magnification ×400. Data are from the Scedosporiosis/lomentosporiosis Observational Study (12).

Figure 4

Abdominal computed tomography scans for case-patient 5 showing aortitis in study of unexpected vascular locations of Scedosporium spp. and Lomentospora prolificans fungal infections, France. A) Arrow indicates abdominal aorta and superior mesenteric artery thickening and perivascular contrast. B) Arrow indicates abdominal aorta and left renal artery thickening and perivascular contrast. Data are from the Scedosporiosis/lomentosporiosis Observational Study (12).

Figure 5

Radiologic and histopathologic analysis of thoracic aortitis in case-patient 6 in study of unexpected vascular locations of Scedosporium spp. and Lomentospora prolificans fungal infections, France. A) Thoracic computed tomography scan showing sacciform aneurysm of ascending aorta (star). B) Thoracic computed tomography scan 21 days later showing the rapidly growing aneurysm (star). C) Hematoxylin-eosin-saffron stain of thoracic aorta section. Star indicates thoracic aorta wall dissection. Triangle indicates tunica media. Scale bar indicates 1 mm. D) Grocott-Gomori methenamine silver stain of thoracic aorta section. Star indicates septate fungal hyphae invading the thoracic aorta tunica media. Triangle indicates thrombus containing septate fungal hyphae. Scale bar indicates 100 μm. Data are from the Scedosporiosis/lomentosporiosis Observational Study (12).