Scedosporium boydii disseminated infection complicating severe SARS-CoV2 infection in an immunocompetent patient: a case report

Abstract

Background: Disseminated disease by species in the Scedosporium genus are rare in immunocompetent patients, and have not been reported in the context of severe SARS Cov-2 infection. Case presentation: A retired, 41-year-old police officer with a history of obesity and arterial hypertension presented to emergency department with acute respiratory hypoxemic failure due to severe SARS-Cov2 pneumonia. He used to practice home aquarium care, biking, river swimming, and fishing. He reported no recent travel to the sea, lakes, or caves. He required prolonged mechanical ventilation, and had several documented episodes of ventilator-associated pneumonia due to Pseudomonas aeruginosa and Klebsiella pneumoniae, which later evolved to necrotizing pneumonia, multiple lung abscesses, bronchopleural fistula, empyema and subpleural abscess. Despite sedation withdrawal he remained unconscious; a brain MRI revealed multiple brain abscesses. Scedosporium boydii was isolated from both lung and brain abscess cultures. In addition to percutaneous drainage of lung abscesses, he was treated with combined therapy with voriconazole and liposomal amphotericin B, considering a possible synergic effect. Drainage of the multiple brain abscesses was not feasible; thus, radiological progression was documented, leading to the patient´s demise despite five weeks of treatment. Conclusion: Invasive fungal infections (IFIs) by molds are an emerging condition in patients with COVID-19. Cases of aspergillosis, candidiasis and mucormycosis were increasingly reported during the COVID-19 pandemic. This is the first report of a fatal disseminated infection due to Scedosporium boydii preceded by a severe SARS Cov-2 infection.