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Seiji Okimasa, Satoshi Shibata, Shinkichiro Yoshioka
Am J Case Rep 2008; 9:411-414
Background: Pseudallescheria boydii (P. boydii) is the most frequent etiological agent of eumycotic mycetoma and is an occasional agent of otomycosis, keratitis, endophthalmitis, meningitis, brain abscess, and osteomyelitis. However, this condition is very rare, and is usually observed in immunocompromised patients. Here, we report a case of pulmonary pseudallescheriasis in a patient without immunity disorder.
Case Report: The patient was a 25-year-old construction worker. He presented to our hospital with hemoptysis, and a chest X-ray revealed nodular shadows in the left upper lung field. Chest computed tomography (CT) revealed infiltration with cavitary nodules. The results of fl exible bronchoscopy examination suggested pulmonary aspergillosis. Pyrexia was observed at the same time. The patient was treated with micafungin sodium (MCFG), but showed no improvement. Later, fungi suspected to be P. boydii were detected on Sabouraud’s agar. Antifungal therapy was changed to administration of voriconazole (VRCZ). Despite the disappearance of pyrexia, the abnormal shadow did not disappear completely, and left upper lobectomy was performed. The patient’s postoperative course was uneventful, and he has been followed up on an outpatient basis without any recurrence.
Conclusions: It is important to consider this disease in cases in which medication using amphotericin B and/or MCFG is not effective under a diagnosis of pulmonary aspergillosis. It is recommended to perform a culture test and PCR without delay. In addition, we believe that surgery for locally invasive disease as in this case may be of value in preventing rapid and fatal dissemination.