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When Emerging Fungal Infections Mimic Tuberculosis: First Reported Case of Invasive Emergomyces europaeus Infection in a Man With Immunocompromise Living in France

Summary

A 65-year-old man living in France who received a kidney transplant developed a serious fungal infection caused by Emergomyces europaeus, a rare fungus that initially appeared to be tuberculosis. Doctors used advanced genetic testing to identify the unusual fungus in samples from his lungs and bone marrow. The patient was treated with a combination of antifungal medications, which successfully cleared the infection. This is the first time this particular fungal infection has been documented in France and highlights how emerging infections can mimic more common diseases.

Background

Emergomycosis is a rare emerging thermally dimorphic fungal infection primarily observed in individuals with HIV, associated with cutaneous, pulmonary, or disseminated manifestations. The genus Emergomyces comprises diverse fungi formerly classified as Emmonsia species. Fewer than 80 proven cases have been reported globally, with most involving E. africanus infection in South Africa.

Objective

To report the first documented case of invasive Emergomyces europaeus infection involving both pulmonary and bone marrow sites in an immunocompromised individual in France. The case highlights the diagnostic complexity, epidemiological rarity, clinical presentation mimicking tuberculosis, and innovative therapeutic approach using novel antifungal agents.

Results

The patient was initially suspected of having tuberculosis but all mycobacterial tests remained negative. Molecular sequencing identified Emergomyces europaeus with 99.83% identity to the type culture. The infection involved both lungs with miliary pattern and bone marrow with pancytopenia. Combined therapy with liposomal amphotericin B and isavuconazole achieved clinical improvement within one week, followed by consolidation therapy with posaconazole.

Conclusion

This is the first reported case of invasive E. europaeus infection in an immunocompromised individual in France, demonstrating the importance of molecular diagnosis in fungal infections mimicking tuberculosis. The case suggests a possible geographic focus in the Rhine region and highlights the effectiveness of combined antifungal therapy. Early diagnosis and recognition of emergomycosis is critical given the high rate of misdiagnosis as tuberculosis.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 41164787, DOI: 10.1093/ofid/ofaf621
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