Ochroconis gallopavum is a rare fungal infection. It is commonly reported in the veterinary literature as a cause of neurological infections in birds. Human infections are attributed to an opportunistic infection in the immunocompromised host. This is a case of an immunocompetent patient with Ochroconis gallopavum infection.
This is a 72 year old man who was referred for anorexia and failure to thrive. Patient noticed a 50 pound weight loss over the past 45 days along with dysnea on exertion. He denied fever, chills, night sweats, coughing, or shortness of breath. Past medical history included osteoarthritis and hypertension. Medications included Atenolol, Aspirin, and Rofecoxib. Physical exam was pertinent for an asthenic appearing male that appeared chronically ill. Patient was a 50 pack year smoker with alcohol use of 1-3 beers per day. He lived in Ohio till the age of 12. Though he has traveled extensively, he lived most of his life in Texas. Pets include a dog and cat. He worked as a jet engine controller with the Air Force, then as a police officer in San Antonio. Pertinent labs included a WBC count of 5.2, hemoglobin 9.2, hematocrit 27. Liver function tests were slightly elevated. Chest radiograph showed bilateral pleural effusions with nodular opacities. Computerized Tomography (CT) scan of the chest showed mediastinal adenopathy, bronchiectasis, multiple pulmonary nodules and a tree-in-bud pattern. Bronchoscopy was performed. bronchial alveolar lavage specimens’ were positive for Mycobacterium Avium Intracellulare Complex (MAC) and fungal elements. Periodic acid-Schiff of transbronchial biopsies showed fungal elements. Cultures from these specimens grew Ochroconis Gallopavum. Respiratory cultures showed Streptococcus Pneumoniae and Pseudomonas Aeruginosa, both sensitive to fluoroquinolones. Fungal titers, hepatitis screen, HIV, blood cultures and CT of the brain were negative. Patient was treated with Gatifloxin showing good results in his symptoms and his CT of the chest, though tree-in-bud pattern persisted. Infectious diseases were consulted and therapy was initiated for MAC (Rifampin, Clarithromycin, and Ethambutol) and Ochroconis Gallopavum (Itraconazole).
Ochroconis gallopavum is a dematiaceous fungi found in soils, wood, and plant matter. It has been isolated from chicken litter and geothermal soils. It has been implicated as an opportunistic infection in immunocompromised humans, associated with transplant and leukemic patients in thirteen reported cases. 50-60% of patients presented with cerebral abscesses. Mortality for systemic infection is high at 46%. There is only one case report of Ochroconis gallopavum infection in an immunocompetent host . Though our patient was immunocompetent, his alcohol abuse, debilitate state and MAC disease may have contributed to an immunosuppressed state. M. Avium lipids have been shown to be immunosuppressive by alteration in a variety of cytokines (IL-10, TNF-Alpha) and eicosanoids (prostaglandin E2) that affect general host response . Treatment consists of a combination of surgical resection, amelioration of immunosuppression, and prolonged antifungal therapy. Length of therapy has not been determined. Successful agents include itraconazole, amphotercin B, and voriconazole. Fluconazole is not useful since the fungus is uniformly resistant to this agent.
This is the first reported case of Ochroconis Gallopavum with concomitant MAC disease in an immunocompetent host. Ochroconis Gallopavum is a rare fungal infection of the immunocompromised host. In this patient, we believe, MAC contributed to an immunosuppressive state.
L. O. Bravo, Jr, None