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Human Adiaspiromycosis: A Case From Argentina FREE TO VIEW

Mariano Fielli, MD; Adrian Ceccato, MD; Paula Capece, OTR; Gladys Posse, OTR; Alfredo Monteverde, PhD; Alejandra Gonzalez, MD
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Hospital Nacional Prof. Dr. Alejandro Posadas, Buenos Aires, Argentina

Chest. 2013;144(4_MeetingAbstracts):220A. doi:10.1378/chest.1703865
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SESSION TITLE: Infectious Disease Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Adiaspiromycosis caused by Emmonsia crescens is primarily a respiratory disease affecting small mammals such as rodents. It has also been described, though rarely, as an etiologic agent of pulmonary pathology in humans, become an accidental host by inhaling dust-borne spores (conidia) of the saprophytic soil fungus, potentially leading to death.

CASE PRESENTATION: We report the case of a 42 years old man, he was a heavy smoker (100 pack/ years), and works in metal recycling. He consulted for fever associated with weight loss, fatigue and debility. Physical examination revealed hemodynamically stable, chest examination indicated increased work of breathing, wheeze, and coarse crackles at the right side. Cardiovascular and abdominal examinations were normal. Chest CT was performed: right upper lobe with parenchymal loss, in both upper lobes pseudonodular images, bullous emphysema, mediastinal and hilar nodes and widespread bud in tree. His CBC analysis revealed a WBC count of 7000 (normal range: 4.1-10.9×103/μL), hematocrit of 42% (normal range: 41%-53%). Electrolyte levels and renal and liver function test results were normal. Urine microscopy did not reveal any active sediments. Serology for antinuclear antibodies and antineutrophil cytoplasmic antibodies were normal, test HIV negative, alpha 1 antitrypsin levels normal too. Sputum smear was negative for Zielh-Neelsen staining. The bronchoscopy performed did not report any endoluminal lesions. Transbronchial biopsy revealed granuloms. The culture was negative for Mycobacteria. The mycological culture was positive for Emmonsia Crescens. The treatment was initiated with amphotericin B followed by itraconazole with clinical improvements. Four years later he consulted again by self-limited hemoptysis, a new TC was perfomed whitch revealed lung architecture alteration in both upper lobes with cystic areas and dense, micro and macronodular images. Mycological culture from sputum was positive for Emmonsia crescens. We restarted itraconazol treatment with good response.

DISCUSSION: Adiaspiromycosis is an unusual pulmonary mycosis. In this case we report a patient with clinical and bacteriological relapse.

CONCLUSIONS: It is uncertain if the optimal management of pulmonary adiaspiromycosis should be supportive or if it should consist of antifungal treatment.

Reference #1: Barbas Filho JV, Amato MBP, Deheinzelin D, Saldiva PHN, Carvalho CRR. 1990. Respiratory failure caused by adiaspiromycosis. Chest 97:1171-1175

Reference #2: England DM, Hochholzer L. 1993. Adiaspiromycosis: an unusual fungal infection of the lung. Am. J. Surg. Pathol. 17:876-886

Reference #3: G Anstea, D Sutton. 2012. Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp. J Clin Microbiol. 50(4): 1346-1354

DISCLOSURE: The following authors have nothing to disclose: Mariano Fielli, Adrian Ceccato, Paula Capece, Gladys Posse, Alfredo Monteverde, Alejandra Gonzalez

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