INTRODUCTION: Scytalidium is a fungus which belongs to group of dematiaceous coelomycete which is a large and heterogeneous group of molds that causes mostly cutaneous, subcutaneous and corneal infections. These organisms are widespread in the environment and they are mostly found in soil, wood and decomposing plant debris. Human infection occurs mainly after traumatic implantation.
CASE PRESENTATION: A 70 year old male presents with recurrent pneumonia. His medical history includes unilateral vocal cord paralysis following meningioma resection, bladder and prostate cancer in 2002 for which he had surgical resection and received chemotherapy. His chest CT scans over the years were significant for right lung patchy opacities with fleeting appearance and mediastinal adenopathy. Radiographic findings were consistent with recurrent pneumonia. One year ago, the Chest CT showed a 0.8 x 1.2 cm nodule in the right middle lobe. Six month follow up scan showed mild increase in size of the nodule. A PET scan was negative for right middle lobe pulmonary nodule, however two right and one left hilar lymph nodes were mildly positive on PET scan. For the last two months, patient had complaints of worsening dyspnea on exertion and occasional wheezing. He received 2 courses of oral antibiotics and bronchodilators without improvement. He underwent a VATS procedure without adverse events. Pathological review showed lung parenchyma with a granulomatous lesion characterized by central necrosis and peripheral palisading histiocytes with multinucleated giant cells. Special staining with GMS was positive for fungal organisms. The fungus was identified as Scytalidium species. Fungal cultures grew same pathogen. Our patient received 4 weeks of voriconazole treatment. Patient’s symptoms improved and he is currently asymptomatic.
DISCUSSION: The Scytalidium species were first reported in 1970 to cause superficial dermatomycosis and onychomycosis clinically undistinguishable from typical dermatophyte infections. Most frequent clinical presentations of invasive infection include brain abscess and abdominal abscesses. This case of invasive Scytalidium infection is unique in organ involved and clinical presentation with recurrent pneumonia and lung nodules. Other distinctive features of this case are absence of immunodeficiency and chronicity of symptoms.
CONCLUSIONS: Optimal therapy of deep Scytalidium infections is not known. Our patient responded well to treatment with voriconazole. Amphotericin B and voriconazole are effective in vitro, however surgical debridement is frequently necessary. In spite of improvement in therapy, this condition is still associated with high morbidity and mortality.
Reference #1 JOURNAL OF CLINICAL MICROBIOLOGY, 0095-1137/97/$04.0010 Feb. 1997, p. 433-440
Reference #2 JOURNAL OF CLINICAL MICROBIOLOGY, Aug. 2004, p. 3789-3794 Vol. 42, No. 8 0095-1137/04/$08.00[|#1#|]0 DOI: 10.1128/JCM.42.8.3789-3794.2004
DISCLOSURE: The following authors have nothing to disclose: John Youssef, Andreea Antonescu-Turcu, Rade Tomic
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