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Life-threatening airway stenosis due to Scedosporium infection during nontuberculous mycobacteria treatment: A case report

Summary

A 73-year-old woman with arthritis treated with immunosuppressive drugs and a lung infection developed a life-threatening narrowing of her airway caused by a rare fungal infection called Scedosporium apiospermum. Doctors used a combination of emergency measures including a breathing support machine, insertion of a special tube to keep the airway open, and strong antifungal medication to treat the infection. After six months of treatment, the fungal infection was completely gone and the special airway tube was successfully removed, allowing normal healing.

Background

Endobronchial fungal infections are uncommon, with Aspergillus being the most frequently reported cause. A 73-year-old female with rheumatoid arthritis on immunosuppressive therapy and pre-existing Mycobacterium avium complex infection presented with life-threatening airway stenosis caused by Scedosporium apiospermum infection.

Objective

To report a case of life-threatening tracheal stenosis caused by endobronchial Scedosporium apiospermum infection and describe the diagnostic and therapeutic management in a patient with comorbid immunosuppression and nontuberculous mycobacteria infection.

Results

Pathological examination initially suggested Aspergillus infection, but MALDI-TOF and genetic analysis identified Scedosporium apiospermum. Voriconazole treatment with therapeutic drug monitoring (target trough 1-4 μg/L) resulted in gradual improvement of endobronchial lesions. The silicone stent was successfully removed after 6 months with complete resolution of fungal infection and no post-inflammatory stenosis.

Conclusion

Urgent endobronchial intervention combined with appropriate antifungal therapy can successfully manage life-threatening fungal airway infections. Accurate pathogen identification is critical for selecting appropriate antifungal agents, and scedosporiosis should be considered in immunocompromised patients with new lower-airway necrotic disease.
  • Published in:Respiratory Medicine Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 41210149
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