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Allergic bronchopulmonary mycosis caused by Scedosporium apiospermum: A case report

Summary

A 61-year-old woman developed a rare fungal infection in her lungs caused by Scedosporium apiospermum while undergoing cancer treatment. The infection caused persistent cough, mucus plugs in the airways, and high levels of immune cells called eosinophils. Doctors used genetic testing to identify the specific fungus and then treated her with corticosteroids and antifungal medications, which improved her condition significantly.

Background

Allergic bronchopulmonary mycosis (ABPM) is a chronic respiratory disease caused by saprophytic fungi, primarily Aspergillus species. Cases caused by Scedosporium apiospermum are extremely rare, with limited data on non-Aspergillus ABPM causative organisms.

Objective

To report a rare case of ABPM caused by Scedosporium apiospermum in a patient without asthma history, utilizing genetic analysis for species identification and demonstrating the application of new Japanese diagnostic criteria for ABPM.

Results

A 61-year-old female presented with persistent cough and dyspnea, elevated eosinophilia, high-attenuation mucus in bronchi, and mucous plugs containing Scedosporium apiospermum confirmed by culture and genetic analysis. Treatment with corticosteroids and antifungal drugs (voriconazole then posaconazole based on drug susceptibility) led to clinical improvement.

Conclusion

This case demonstrates that ABPM caused by non-Aspergillus fungi like S. apiospermum can occur in patients without asthma or elevated IgE levels. Species identification through genetic analysis is crucial for appropriate antifungal selection, as antifungal susceptibility varies significantly among fungal species.
  • Published in:Respiratory Medicine Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39263247, DOI: 10.1016/j.rmcr.2024.102092
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