Pulmonary Phaeohyphomycosis in a Patient with Hemoptysis

doi:10.1378/chest.95.5.1158

Chest

Volume 95, Issue 5, May 1989, Pages 1158-1160

https://doi.org/10.1378/chest.95.5.1158 Get rights and content

A 79-year-old retired schoolteacher had a history of bronchiectasis. She developed recurrent hemoptysis requiring multiple blood transfusions. Exophiala dermatitidis was cultured repeatedly from bronchial lavages. To our knowledge, this is the first documented case of isolated pulmonary phaeohyphomycosis due to E dermatitidis, and it was successfully treated with amphotericin B and 5-fluocytosine.

Section snippets

CASE REPORT

A 79-year-old white woman (an unmarried retired schoolteacher) had a history of recurrent hemoptysis. A bronchoscopy in 1979 failed to demonstrate any cause of bleeding. Cultures of the secretions taken at bronchoscopy were negative for pathogenic microorganisms. Based upon the history, findings on bronchoscopy, and x-ray films, she was thought to have and was treated for bronchiectasis involving the lingula of the lung. She continued to have occasional episodes of hemoptysis. Past medical

DISCUSSION

Phaeohyphomycoses are cutaneous and systemic infections characterized by darkly pigmented, septate hyphae present in the tissue.⁸ They are caused by a heterogeneous group of imperfect black (dematiaceous) fungi which contain a cytoplasmic melanin-like pigment that appears to have etiologic significance by decreasing susceptibility of these organisms to antifungal agents.⁹ Taxonomic characterization of these fungi is controversial, so the names given to these fungi are extremely variable and

ACKNOWLEDGMENT

We are grateful to Dr. K. J. Kwon-Chung, Senior Investigator, Clinical Mycology Section, National Institute of Allergy and Infectious Diseases, for identification of the E dermatitidis and for a critical review of this manuscript.

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A 65-year-old Japanese woman repeatedly withdrew and resumed antibiotics against pulmonary non-tuberculous mycobacterial infection caused by Mycobacterium intracellulare for more than 10 years. Although she continued to take medications, her respiratory symptoms and chest computed tomography indicated an enlarged infiltrative shadow in the lingular segment of the left lung that gradually worsened over the course of a year or more. Bronchoscopy was performed and mycobacterial culture of the bronchial lavage fluid was negative, whereas Exophiala dermatitidis was detected. After administration of oral voriconazole was initiated, the productive cough and infiltrative shadow resolved. There are no characteristic physical or imaging findings of E. dermatitidis, and it often mimics other chronic respiratory infections. Thus, when confronting refractory non-tuberculous mycobacterial cases, it might be better to assume other pathogenic microorganisms, including E. dermatitidis, and actively perform bronchoscopy.
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Chest

Pulmonary Phaeohyphomycosis in a Patient with Hemoptysis

Section snippets

CASE REPORT

DISCUSSION

ACKNOWLEDGMENT

Am Acad Dermatol

Cerebral chromomycosis

Arch Neurol

Cerebral chromoblastomycosis, complicated by meningitis and multiple fungal aneurysms after resection of a granuloma

J Neurosurg

Granulomatous encephalitis caused by Drechslera spicifera

Am J Clin Pathol

Cerebral phaeohyphomycosis

Clin Neuropath

Phaeohyphomycosis: definition and etiology

Scientific publications of the Pan American Health Organization

Hematogenous dissemination in chromoblastomycosis

Arch Dermatol