P41. Scedosporium apiospermum mycetoma in a lung cancer patient—case report
Nektarios Alevizopoulos1, Apostolos Laskarakis1, Theodoros Vagdatlis2, Vasiliki Ntalapera2, Anna Skoula2, Theodoros Tegos1, Theodoros Argirakos3, Charis Margariti1, Michail Vaslamatzis1
Background: Scedosporium apiospermum is a rare opportunistic pathogen that may lead to life-threatening infections in immunosuppressive patients. We report a case of Scedosporium apiospermum infection in a lung cancer patient host.
Methods and results: A 72-year-old man was consecutively admitted in our department for his adjuvant chemotherapy post right upper lobectomy due to adenocarcinoma. He suddenly complained of cough and chest burning with dull presentation. The cough produced brown sputum but no blood. He attributed his cough to exposure to cold since he was a fisherman but denied any history of respiratory symptoms. He had no history of tuberculosis or contact with infected persons. He denied a history of severe lung infection, asthma, sinus disease, or overseas travel. His physical examination was notable with no abnormal signs, oxygen saturation of 98% on room air. In general, he was thin, although well in appearance, and not visibly short of breath. His lungs were clear to auscultation. Laboratory studies and urinalysis were normal. A chest radiograph showed a 3-cm by 2-cm mass with a surrounding cavity in the right upper lobe. A subsequent chest CT scan showed a 3-cm by 4-cm cavity in the right upper lobe, with surrounding infiltrates as mass within the cavity suspicious for a fungus ball. Since galactomannan antigen was found negative. Broncho-alveolar lavage material from right median lobe cultured S.apiospermum and patient started voriconazole therapy for 3 months with no toxicity noticed. His recent imaging and bronchoscopic evaluation was with no evidence of fungal infection.
Conclusions:This report presents the first imaging report of lung scedosporiosis. Prompt identification is critical because of its resistance to most antifungal drugs. Its histopathology features are indistinct and overlap with those of more commonly recognized hyalohyphomycetes such as Aspergillus. Cultures from infected tissue are generally required for correct identification. Clinicians and pathologists must be familiar with this organism and recognize the need for culture studies in addition to histopathology in the evaluation of specimens from immunocompromised patients with suspected fungal infection.
Keywords: Lung cancer; pathogen
doi: 10.3978/j.issn.2218-6751.2014.AB053
