Paecilomycosis Lilacinus Infection of the Immunocompromised Host

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Chest Infections II SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Although ubiquitous in distribution the fungus Paecilomycosis lilacinus (P lilacinus) is an extremely rare cause of human disease. It has been reported to cause skin and subcutaneous tissue infection as well as oculomycosis, cutaneous and subcutaneous infection not only in immunocompromised but also in immunocompetent hosts. The number of reported cases of lung infection with this pathogen is very scarce. We report a case of P lilacinus presenting with severe restrictive lung disease. CASE PRESENTATION: A 69 year old female with long term history of extensive psoriasis treated with methotrexate and adalimumab presented for evaluation of chronic cough and sputum production for 2 years. The cough was present throughout the day, often with prolonged coughing fits, and occasionally woke the patient up from sleep. She had been bringing up 4-5 teaspoons of green to yellow sputum almost every day for 2 years. She denied any fever, night sweats, hemoptysis, weight loss or history of treatment for any lung disease. Chest X-ray showed chronic interstitial disease. Pulmonary function tests revealed a severe restrictive ventilator defect with moderate reduction in gas exchange. High resolution computed tomography (HRCT) of the chest was significant for bronchiectasis with multiple small nodules, suspicious for infection but no fibrosis. Labs, including ANA, rheumatoid factor, serum immunoglobulin, CFTR gene mutation were normal. A subsequent bronchoscopy with lavage was done and the fungal culture came back positive for Paecilomycosis lilacinus. DISCUSSION: P lilacinus is a filamentous fungus that is responsible for devastating oculomycosis especially in patients with intraocular lens implantation or ocular surgery. It also causes cutaneous and subcutaneous infection in both immunocompromised and immunocompetent patients. Very rarely this fungus has been reported to cause infection at other body sites, with sinusitis being the most common. Lung involvement is extremely rare and only one case of lung abscess has been reported in the literature. To our knowledge, this is the first case of chronic lung infection by P lilacinus presenting as restrictive lung disease. Although it causes a non fatal infection, the treatment is very difficult as the fungus is often resistant to commonly used antifungal medications. CONCLUSIONS: P lilacinus is an emerging pathogenic mold that poses potential threat particularly in the ever expanding population of immunocompromised patients. The incidence in immunocompetent patient is also increasing. This pathogen might become a challenge in managing immunocompromised patients with structural lung disease in near future. Reference #1: Nayak DR, Balakrishnan R, Nainani S, Siddique S: Paecilomyces fungus infection of the paranasal sinuses. Int J Pediatr Otorhinolaryngol. 2000, 52: 183-187. 10.1016/S0165-5876(00)00282-2. DISCLOSURE: The following authors have nothing to disclose: Biplab Saha, Himani Sharma, Kristin Fless, Paul Yodice, Fariborz Rezai, Nirav Mistry, Vagram Ovnanian No Product/Research Disclosure Information