Pulmonary Scedosporiosis

Abstract

A case of a solitary pulmonary nodule due to Scedosporium apiospermum (Pseudallescheria boydii) is related. A review of the pertinent literature was done and, in addition, similar lesions caused by other opportunistic fungi are commented.

Clinical characteristics and epidemiology of pulmonary pseudallescheriasis

“…The "air crescent sign" is considered 150 57/F Lung abscess NS 37/M Antibiotics, AMB (a total of 576 mg) Van der Vliet et al 143 15/M NS Meadow et al 88 15/F Antibiotics, methylprednisolone (1 g/d), then reduced (to 10 mg/d over 10 d), MCZ (i.v. 1200 mg every 8 h) Gumbart 54 39/M Nodular bilateral pneumonia NS De Ment et al 34 60/F Necrotizing bronchopneumonia, pleuritis Empirically antibiotics and MCZ, changed to AMB (0.3 mg/kg/d) Enggano et al 39 16/M Lung abscess Antibiotics, empirically AMB (i.v.0.75 mg/kg/d), 5-FC Shih and Lee 128 22/M Lung abscess Brain, thyroid, kidney, lumen and wall of vessels None Smith et al 130 41/M Lung abscess Brain, skin, liver, thyroid AMB Guyotat et al 55 26/M Fungal abscess AMB (1 mg/kg) (worsened with diffuse infiltrates) Anaissie et al 7 7/F Lung abscess Heart, blood, kidney, brain abscess None Dworzack et al 37 22/F Lung abscess Brain, skin Surgery MCZ (10 mg every 12 h) (a total of 52 g parenterally and 250 mg intrathecally) 20/F Lung abscess Brain, skin AMB (a total of 86 mg) Schawrtz 121 43/M Lung abscess Kidney, skin, cerebral fungus ball None Patterson et al 101 22/M Cavitary lesions in both lungs, likely nosocomial infection AMB + KTZ (400 mg/d, 12 d), MCZ (600 mg every 8 h) Piens et al 104 33/F AMB (400 mg/kg/d) Steens et al 132 28/F Atypical pneumonia Antibiotics (initially erythromycin and then doxycycline, 1 m); broad spectrum antibiotics Walsh et al 146 13/M Pneumonia AMB 41/M Right upper lobe consolidation Peritonitis on day 86 AMB (70 mg/d) Hofman et al 61 47/M NS Anaissie (1989) 7/F None Severo et al 124 41/F Solitary pulmonary nodule KTZ (400 mg/d), prednisone (20 mg/d) and insulin Khurshid et al 70 61/F Lung abscess Liver, spleen, kidney, pancreas, right and left ventricles AMB Kusne et al 74 ; Castiglioni et al 22 67/M Lung mass ITZ (oral, 1 m), VRZ (6 mg/kg every 12 h the first day, 4 mg/kg every 12 h thereafter) Bonduel et al 15 18/F Pneumonia, pleural effusion ITZ (200 mg/d, 90 d), L-AMB (2 mg/kg/d, a total dose of 30 mg/kg) Breton et al 17 61/M Pneumonia Right pneumonectomy ITZ (400 mg/d), Dinesha et al 35 36/M Brain Anti-tuberculose treatment, frontal craniotomy and excision of the lesion in the left frontal lobe, AMB Nguyen 98 78/F ITZ (oral), AMB (i.v. ), L vitrectomy, (after identification) changed to ITZ ...…”

“…16,22,34,45,54,82,86,103,136 tract samples gave negative results. In one patient a thoracic needle aspiration was performed and the diagnosis was made by examining a stained smear specimen and culture 124 ; diagnosis was made postmortem in nine cases. A histopathological study of nodules was made on some patients, and revealed a round pulmonary ischemic infarction due to arterial invasion by the fungus, 42 granuloma with central necrosis, 151 fibrosis mixed with granuloma and microabscess or an abscess.…”

Respiratory tract intracavitary colonization due to Scedosporium apiospermum: report of four cases

“…Fungus ball consists of a mass of hyphal colonizing a cavity. The suffix "oma" must be restricted to fungal pulmonary nodule 11 . An additional confusion arose from the SCHWARTZ 12 publication of a lung sequestrum by S. apiospermum termed fungoma (fungus ball).…”