Systemic Scedosporium apiospermum Infection Affecting Multiple Sites After Near-Drowning: A Case Report

Abstract

Scedosporium apiospermum (S. apiospermum) can cause fungal infections in near-drowning victims, and an increasing number of cases have been reported. However, cases of bone and joint infections caused by S. apiospermum are rare. In this case, a 35-year-old otherwise healthy Chinese female presented with aspiration pneumonia and knee arthritis after accidentally falling into sewage and near-drowning and underwent macrogenomic second-generation sequencing of arthrocentesis fluid, which showed S. apiospermum. However, new lesions involving the hip joint and spine continued to develop under voriconazole monotherapy. The patient was treated with voriconazole combined with amphotericin B cholesterol sulfate lipid complex for 30 consecutive days. The patient's symptoms improved significantly. This case highlights the robust invasiveness of S. apiospermum and the extensive spread of infection, underscoring the importance of prompt diagnosis and treatment. A combined therapeutic approach may offer a safe and efficacious option for managing S. apiospermum infection.

Keywords: Scedosporium apiospermum; amphotericin B cholesterol sulfate lipid complex; metagenomic next-generation sequencing; near-drowning; voriconazole.

Figure 1

Lung computed tomography findings: (a and b) Multiple nodules and patchy shadows were seen in both lungs (red arrow) (November 20, 2023). (c and d) The number of lesions was decreased in both lungs, changes in lungs during the recovery period (red arrow) (February 23, 2024).

Figure 2

Lumbar spine magnetic resonance imaging: (a) pathological changes in L₃ and L₄ vertebral, and L₃/L₄ intervertebral disks, showing vertebral osteomyelitis and diskitis (black circle) (November 20, 2023). (b) Changes in lumbar vertebrae during the recovery period (black circle) (February 23, 2024).