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Schizophyllum commune infection following chimeric antigen receptor T-cell therapy in a patient with lymphoma

Summary

A 71-year-old woman receiving CAR T-cell therapy for lymphoma developed a rare fungal lung infection caused by Schizophyllum commune six months after treatment. The infection presented similarly to other fungal diseases affecting the lungs and was diagnosed through bronchoscopy and fungal culture despite negative blood antibody tests. Standard antifungal medication (voriconazole) taken by mouth for four months completely resolved the infection, highlighting the need to consider rare fungi in patients receiving advanced cancer immunotherapies.

Background

Infectious complications are common following CAR T-cell therapy for B-cell lymphoma due to prolonged immunosuppressive effects. Schizophyllum commune is an exceedingly rare fungal pathogen that typically affects the respiratory tract and may mimic chronic pulmonary aspergillosis. Previous S. commune infections have been reported primarily in recipients of allogeneic hematopoietic stem cell transplantation.

Objective

To report the first documented case of S. commune infection in a patient treated with CAR T-cell therapy for primary refractory large B-cell lymphoma and to discuss the diagnostic and therapeutic challenges posed by this rare fungal infection in the context of B-cell aplasia.

Results

Six months post-CAR T-cell therapy, the patient developed persistent cough and right middle lobe atelectasis with high-attenuation mucus. Bronchoscopic findings revealed thick yellowish mucus obstruction. Fungal culture and ITS sequencing confirmed S. commune infection presenting as allergic bronchopulmonary mycosis. Notably, serologic tests were negative for fungus-specific IgG and IgE. The patient responded favorably to 4 months of oral voriconazole therapy with complete resolution of symptoms and radiologic findings.

Conclusion

This case represents the first known S. commune infection following CAR T-cell therapy, demonstrating that rare fungal infections can occur in this patient population. B-cell aplasia resulting from CAR T-cell therapy complicates serologic diagnosis by causing false-negative results. Antifungal monotherapy with voriconazole was effective, suggesting it may be a reasonable alternative to corticosteroid-antifungal combination therapy in selected CAR T-cell recipients.
  • Published in:Journal of Clinical and Experimental Hematopathology,
  • Study Type:Case Report,
  • Source: PMID: 41016810, DOI: 10.3960/jslrt.25043
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