Pseudallescheria boydii (Scedosporium species) in 3 Lung Transplant Recipients

Abstract

The objective of our study was to evaluate chest computed tomography (CT) findings in 3 lung transplant recipients infected with Pseudallescheria boydii complex or its asexual anamorph, Scedosporium apiospermum, 2 after double-lung transplant and 1 after single-lung transplantation. Awareness and early diagnosis of this rare but potentially lethal infection are important, as it is largely refractory to treatment with the antifungal agents of choice used for the more common Aspergillus species. Computed tomography investigation focused on the location, quality, and appearance of the various pulmonary lesions as well as the presence of cavitation, mediastinal lymphadenopathy, and pleural effusions. A literature review of previous lung and other solid organ transplant recipients infected with pulmonary Pseudallescheria boydii was also conducted and compared with our findings. While the high-resolution CT findings of pulmonary P. boydii infection are nonspecific and markedly similar to the manifestations of the more common Aspergillus species, awareness of this rare opportunist is important, given the high mortality associated with disseminated infection and the relative success possible with timely and appropriate treatment. The most common CT abnormalities present in our 3 patients included hilar and paratracheal adenopathy, noncavitary tree-in-bud nodules surrounded by ground-glass opacities, and airway thickening.