Following the description of allergic bronchopulmonary Aspergillosis (ABPA), patients with clinical pictures similar to those with ABPA have been described leading to the new term allergic bronchopulmonary Mycosis (ABPM).Implicated fungi in the pathogenesis of ABPM include Aspergillus Sp. other than A. fumigatus, Candida albicans, Curvularia lunata, Mucor Sp., Penicillium, Torulopsis glabrata, and Scedosporium apiospermum. (1)
A 42-year-old white female, known to have childhood asthma, with more frequent attacks for the last 8 years.The patient was treated in the past 4 years intermittently with Prednisone and itraconazole, was presumed to have ABPA based on the isolation of aspergillus in the sputum, asthma, the central Bronchectasis, and LgE level of 3534 mg/dl.The precipitin test was weakly positive for Aspergillus (1 band).The patient’s family history is notable for a 1-year-older sister with Kartagener syndrome.Electronmicroscopy of bronchial wall brush showed dynine arms abnormalities and absent inner arms c/w partial immotile cilia disorder. (Fig. 1)The BAL grew Scedosporium Apiopremum (Fig. 2) and Mycobacterium Chelonae.Her IgE level was 3085 mg/dl.The patient was restarted on Itraconazole, prednisone, and Clarythromycin and showed significant improvement thereafter.DISCUSSION: Scedosporium apiospermum is a ubiquitous saprophyte that has been isolated from soil, animal feces, and polluted water.Pulmonary scedosporiosis may be caused by S. apiospermum, a rare event that usually occurs on a previous damaged lung tissue such as a cavity, bronchiectasis or a lung cyst, leading to the development of a mycetoma (2). It may also cause allergic bronchopulmonary reaction (3). In immunocompromised patients, invasive infections may sometimes occur (4).
Scedosporium apiospermum can cause ABPM and can be easily confused with Aspergillus. Because S. apiospermum is most often resistant to amphotericin B and sometimes sensitive to azole derivatives, differentiation is essential.
A.Y. Al-Astal, None.