Available online 13 March 2023
Author links open overlay panel, , , , , , , , , , , , , , , AbstractA 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.
Section snippets1IntroductionExophiala dermatitidis is a dematiaceous fungus characterized by the presence of melanin in the cell wall and its ability to switch from the yeast-like state to the hyphal state [1]. In addition to skin and soft tissue infections [2], pulmonary chromoblastomycosis [[3], [4], [5], [6], [7]] has been reported in patients with chronic lung infections. Here, we report a case of pulmonary chromoblastomycosis diagnosed using bronchoscopy during the long-term treatment of pulmonary non-tuberculous
Case reportA 65-year-old Japanese woman was noted to have a granular shadow on a chest radiograph during a physical examination 11 years prior. She was employed as an office worker and had no notable history of soil or dust exposure. Chest computed tomography (CT) showed a granular shadow, an infiltrative shadow, and bronchiectasis in the lingual segment of the left lung. The culture of bronchial lavage fluid from the same site showed Mycobacterium intracellulare, and pulmonary non-tuberculous
DiscussionIn general, when non-tuberculous mycobacterial infections do not improve with standard antimicrobial therapy, macrolide resistance should be suspected. Koh et al. reported that clarithromycin resistance occurred in 29% of patients who relapsed with nontuberculous mycobacterium infections following initial treatment [8]. This patient repeatedly stopped and resumed antimicrobial therapy; therefore, we first raised the possibility of macrolide-resistant non-tuberculous mycobacterium infection.
Authorship statementAll authors meet the ICMJE authorship criteria.
Funding sourcesThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Consent for publicationInformed consent was obtained from the patient for the publication of this case report and may be made available upon request.
Authors’ contributionsDS and NI wrote the manuscript. YI, NA, TH, KT, SI, TT, KI, KY, and HM provided conceptual advice. All authors participated in drafting, critically revising, and approving the final version of the manuscript.
Declaration of competing interestNone.
AcknowledgementsNone.
References (30)F. Grenouillet et al.Exophiala dermatitidis revealing cystic fibrosis in adult patients with chronic pulmonary diseaseMycopathologia
(2018)
R. Sekiguchi et al.Exophiala dermatitidis pneumonia with bronchiectasis required prolonged voriconazole treatmentRespirol Case Rep
(2021)
Y. Watanabe et al.Sinobronchial syndrome patients with suspected non-tuberculous mycobacterium Infection exacerbated by Exophiala dermatitidis InfectionInfect Drug Resist
(2022)
W.J. Koh et al.Outcomes of Mycobacterium avium complex lung disease based on clinical phenotypeEur Respir J
(2017)
M.N. Babič et al.Ecology of the human opportunistic black yeast exophiala dermatitidis indicates preference for human-made habitatsMycopathologia
(2018)
View full text© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
留言 (0)