Chest Infections |

Scedosporium apiospermum: A Rare Case of Cavitary Lung Disease FREE TO VIEW

Nidhi Aggarwal, MBBS; Anand Kumar Rai, MBBS; Sepideh Sedgh, DO; Mangalore Amith Shenoy, MBBS; William Pascal, MD; Yizhak Kupfer, MD; Igor Brichkov, MD
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Maimonides Medical Center, Brooklyn, NY

Chest. 2015;148(4_MeetingAbstracts):158A. doi:10.1378/chest.2281292
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SESSION TITLE: Infectious Disease Cases II

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Wednesday, October 28, 2015 at 11:00 AM - 12:15 PM

INTRODUCTION: Scedosporium apiospermum (SA) is an extremely rare cause of cavitary lung disease. It is a rare opportunistic fungus that can cause infection in a patient with underlying damaged lung tissue or in an immunocompromised host1. We report a case of a young male presenting with hemoptysis that was found to have a cavitary lung infection caused by SA

CASE PRESENTATION: A 58 year old male presented with 4 days of blood tinged sputum. He had a history of Mycobacterium Tuberculosis (TB) 10 years ago which was successfully treated with 6 months of anti-TB drugs. He denied any fever, weight loss, appetite loss and night sweats. His Chest X- ray showed a right upper lobe mass. CT chest revealed dense consolidation in the right upper lobe with cavitary changes (Image 1, 2). Sputum AFB was negative. Bronchoalvelar lavage (BAL) and transbronchial biopsy was done to establish the diagnosis. After 3 weeks, the BAL culture grew SA. He is being treated with voriconazole and is currently feeling better.

DISCUSSION: Patients with underling lung damage are predisposed to colonization by opportunistic organisms that can cause cavities. Pulmonary infection by SA is usually caused by inhalation. Pulmonary manifestations can vary from cavitary lung disease, pulmonary fungus ball, allergic bronchopulmonary Scedosporium pneumonia (ABSP) to invasive pulmonary infection. It is important to recognize S. apiospermum infection because these are difficult to manage due to intrinsic resistance to many antifungal agents. Pulmonary infections may be successfully treated with azole antifungals; voriconazole is often recommended due to a higher success rate compared to other agents2. Treatment duration is not established and can often range from 3 months to a year .Treatment failure is common and patients may eventually need surgical resection.

CONCLUSIONS: SA is an extremely rare opportunistic infection that can cause severe infections in immunocompromised patients and in patients with previously damaged lungs. SA has a high rate of resistance and treatment failure. Voriconazole is the drug of choice based on better success rates as compared to other agents. It requires long duration of treatment and some patients may require surgical resection.

Reference #1: Guarro J et al; Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist; Medical Mycology, June 2006;44(4):295-327.

Reference #2: Peter Troke et al, Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients; Antimicrob. Agents Chemother. 52:1743-1750.

DISCLOSURE: The following authors have nothing to disclose: Nidhi Aggarwal, Anand Kumar Rai, Sepideh Sedgh, Mangalore Amith Shenoy, William Pascal, Yizhak Kupfer, Igor Brichkov

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