Breakthrough lung Scedosporium prolificans infection with multiple cavity lesions in a patient receiving voriconazole for probable invasive aspergillosis associated with monoclonal gammopathy of undetermined significance (MGUS)

Abstract

Breakthrough non-Aspergillus mold infections among patients receiving the anti-mold azole antifungal agents like voriconazole or posaconazole have been increasingly reported. We report a case of lung Scedosporium prolificans infection with multiple cavities in a 58-year-old man with monoclonal gammopathy of undetermined significance(MGUS)during voriconazole treatment for probable invasive aspergillosis. Cultures of repeated sputum specimens yielded the same fungus until his death 83 days after diagnosis. S. prolificans should be considered in patients with breakthrough infections receiving voriconazole.

Infective endocarditis caused by Scedosporium prolificans infection in a patient with acute myeloid leukemia undergoing induction chemotherapy

“…The first Japanese case was reported in 2011. To date, four cases, including the one presented herein, have been reported in Japan (Table 2) [9][10][11]. S. prolificans is an environmental pathogen, and was detected (along with other pathogens) in bronchoalveolar lavage fluid from a survivor of the tsunami caused by the Great East Japan Earthquake in 2011 [13].…”

“…S. prolificans infection tends to be more prevalent in Australia, the United States, and southern European countries, particularly Spain [5][6][7][8]. The first Japanese case of S. prolificans infection was reported in 2011 [9], and two cases have been described during the last 3 years [10,11]; thus we must recognize S. prolificans as a significant pathogen and be aware of the characteristics and management of this infection.…”

The Effective Treatment of Lung Infection Due to <i>Scedosporium prolificans</i> with Voriconazole and Surgery

“…In Japan, only a few cases of lung infection due to S. prolificans have been reported (4, 6, 7). All of the patients in these cases died within a few days to a few months after the onset of disease; in contrast, our patient survived.…”

“…S. prolificans is resistant to most clinically available antifungal agents (3, 6). As such, S. prolificans infection is often fatal after dissemination to multiple organs.…”

“…Immunocompromised or immunosuppressed patients, including patients with HIV, organ transplant recipients, hematopoietic stem cell transplant recipients, and patients with hematologic malignancies, are more likely to be infected with Scedosporium (3, 4, 6). However, one study reported that 21% of 270 patients with Scedosporium infection were immunocompetent (1).…”