Fungal ball due to a species of the Scedosporium apiospermum complex in a post-tuberculosis patient

Background

Scedosporium species are considered emerging pathogens causing illness in immunocompetent and immunocompromised hosts.

Case report

A case of non-invasive pulmonary (fungal ball) infection by Scedosporium apiospermum complex in a 49-year-old female with bronchiectasis and cavities secondary to tuberculosis is described. The patient had a history of three years of cough and hemoptysis. A computed tomography scan of the thorax revealed the presence of a cavity in the lower lobe of the right lung, associated with bronchiectasis. A combination of surgical debridement and antifungal therapy (voriconazole) was the treatment of choice. Pulmonary resection (right lower lobectomy) was performed, and samples were sent for microbiological culture and histopathological examination; by means of the latter technique, hyphae were shown. The identification of Scedosporium angustum, a phylogenetic species of the S. apiospermum complex, was obtained by amplifying and sequencing the β-tubulin locus. Voriconazole therapy was started at a loading dose of 800 mg/12 h for the first 24 h, followed by 200 mg/12 h for 6 months. The patient responded favorably to the treatment and remained asymptomatic.

Conclusions

This case emphasizes the importance of considering Scedosporium species in the differential diagnosis of fungal balls by Aspergillus.

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