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Yoshinouchi T, Yamamoto K, Migita M, Yokoyama T, Nakamura T, Matsuoka M. Diagnosis and clinical management of Exophiala dermatitidis pneumonia in a patient with anorexia nervosa: A case report. Med Mycol Case Rep 2023; 42:100617. [PMID: 38022890 PMCID: PMC10661607 DOI: 10.1016/j.mmcr.2023.100617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
We report a patient with anorexia nervosa without bronchiectasis and cystic fibrosis who developed acute pneumonia caused by Exophiala dermatitidis (E. dermatitidis). The black fungus found in multiple sputum cultures was determined to be E. dermatitidis using mass spectrometry and identified using genetic analysis. Although the initiation of antifungal therapy was late, the pneumonia gradually improved with long-term treatment. This case highlights the need for early diagnosis and effective long-term treatment of the fungal etiologic agent.
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Affiliation(s)
- Tatsuya Yoshinouchi
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
| | - Keiichi Yamamoto
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
| | - Mitsuru Migita
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Toshiro Yokoyama
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
| | - Tomofumi Nakamura
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Masao Matsuoka
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
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Miyoshi S, Tanabe M, Semba M, Sato C, Aoyama S, Watanabe A, Ito R, Hamada K, Watanabe A, Abe M. Exophiala dermatitidis coinfection with nontuberculous mycobacteria: A case report and literature review. Respirol Case Rep 2023; 11:e01221. [PMID: 37711651 PMCID: PMC10498155 DOI: 10.1002/rcr2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Six years ago, a 60-year-old man presented to our hospital with a cough and sputum. Upon suspicion of nontuberculous mycobacterial (NTM) infection, he was followed up at our hospital. Because the abnormal shadows in the bilateral lung fields deteriorated slightly over 6 years, bronchoscopy was performed. Exophiala dermatitidis and Mycobacterium intracellulare were detected in the bronchial lavage fluid. The patient underwent follow-up examinations without drug administration. Currently, the patient's condition remains stable. E. dermatitidis is regulatory found in the lungs of patients with cystic fibrosis, but only rarely is it found in respiratory samples from patients without cystic fibrosis. However, NTM complications have been reported more frequently in recent years. Due to the increasing number of NTM patients, E. dermatitidis pulmonary infections may also increase. Additional research is required to develop strategies for treating this infection.
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Affiliation(s)
- Seigo Miyoshi
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Miyuki Tanabe
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Mayuko Semba
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Chika Sato
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Sanae Aoyama
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Akira Watanabe
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Ryoji Ito
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Kumi Hamada
- Department of Clinical laboratoryNational Hospital Organization Ehime Medical CenterTōonJapan
| | - Akira Watanabe
- Medical Mycology Research CenterChiba UniversityChibaJapan
| | - Masahiro Abe
- Department of Respiratory medicineNational Hospital Organization Ehime Medical CenterTōonJapan
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Pulmonary phaeohyphomycosis due to Exophiala dermatitidis in a patient with pulmonary non-tuberculous mycobacterial infection. J Infect Chemother 2023; 29:615-619. [PMID: 36921763 DOI: 10.1016/j.jiac.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
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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Watanabe Y, Sano H, Konno S, Kamioka Y, Hariu M, Takano K, Yamada M, Seki M. Sinobronchial Syndrome Patients with Suspected Non-Tuberculous Mycobacterium Infection Exacerbated by Exophiala dermatitidis Infection. Infect Drug Resist 2022; 15:1135-1141. [PMID: 35340672 PMCID: PMC8948093 DOI: 10.2147/idr.s359646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Exophiala dermatitidis is an environmental black fungus that rarely causes respiratory infections, yet its pathophysiological features and treatment regimens have not been established. Case Series Two cases of exacerbations of chronic bronchitis and sinusitis due to E. dermatitidis infection in Japan are presented. Both patients were women, and non-tuberculous Mycobacterium (NTM) infection was suspected based on chest radiological findings, but E. dermatitidis was detected from bronchial lavage fluid and nasal mucus, respectively. Both cases were successfully treated by antifungal agents such as liposomal amphotericin B, voriconazole, and itraconazole, but clarithromycin, rifampicin, ethambutol, and sitafloxacin for NTM were not effective. Conclusion E. dermatitidis can become a respiratory pathogen, especially in patients with chronic sinobronchial syndrome.
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Affiliation(s)
- Yuji Watanabe
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
- Laboratory for Clinical Microbiology, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
| | - Hirohito Sano
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Shuichi Konno
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Yasuhiro Kamioka
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
- Division of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
| | - Maya Hariu
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
- Laboratory for Clinical Microbiology, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
| | - Kazuki Takano
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
- Laboratory for Clinical Microbiology, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Masafumi Seki
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
- Correspondence: Masafumi Seki, Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8612, Japan, Tel +81-22-259-1221, Fax +81-22-290-8956, Email ;
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Sekiguchi R, Urabe N, Sakamoto S, Sasaki M, Homma S, Kishi K. Exophiala dermatitidis pneumonia with bronchiectasis required prolonged voriconazole treatment. Respirol Case Rep 2021; 9:e00783. [PMID: 34084534 PMCID: PMC8144837 DOI: 10.1002/rcr2.783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
Exophiala dermatitidis is a black fungus that rarely causes respiratory infection. We report a case of E. dermatitidis pneumonia with bronchiectasis that relapsed after 11 months of voriconazole (VRCZ) treatment in a rheumatoid arthritis (RA) patient with bronchiectasis. A 65-year-old woman with RA and abnormal findings on chest radiography was referred for assessment of chronic cough and increased sputum production. She underwent bronchoscopy, and E. dermatitidis was identified from bronchoalveolar lavage fluid (BALF). Exophiala dermatitidis chronic lower respiratory tract infection and pneumonia were diagnosed. Although her condition improved after 11 months of VRCZ treatment, chest computed tomography (CT) images showed worsening at five months after the cessation of VRCZ treatment and E. dermatitidis was again detected in BALF. Re-administration of VRCZ for two years improved symptoms and chest CT images, and her condition is currently stable. In patients with bronchiectasis, E. dermatitidis pneumonia might require prolonged antifungal treatment.
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Affiliation(s)
- Ryo Sekiguchi
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Naohisa Urabe
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Susumu Sakamoto
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
| | - Masakazu Sasaki
- Department of Clinical LaboratoryToho University Omori Medical CenterTokyoJapan
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Disease ResearchToho University School of MedicineTokyoJapan
| | - Kazuma Kishi
- Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
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Invasive Fungal Infection Caused by Exophiala dermatitidis in a Patient After Lung Transplantation: Case Report and Literature Review. Mycopathologia 2018; 184:107-113. [DOI: 10.1007/s11046-018-0275-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/27/2018] [Indexed: 12/20/2022]
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Exophiala dermatitidis pneumonia successfully treated with long-term itraconazole therapy. J Infect Chemother 2014; 20:446-9. [DOI: 10.1016/j.jiac.2014.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/22/2014] [Accepted: 02/27/2014] [Indexed: 11/18/2022]
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Rimawi BH, Rimawi RH, Mirdamadi M, Steed LL, Marchell R, Sutton DA, Thompson EH, Wiederhold NP, Lindner JR, Boger MS. A case of Exophiala oligosperma successfully treated with voriconazole. Med Mycol Case Rep 2013; 2:144-7. [PMID: 24432241 PMCID: PMC3885957 DOI: 10.1016/j.mmcr.2013.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022] Open
Abstract
Exophiala oligosperma is an uncommon pathogen associated with human infections, predominantly in immunocompromised hosts. Case reports of clinical infections related to E. oligosperma have been limited to 6 prior publications, all of which have shown limited susceptibility to conventional antifungal therapies, including amphotericin B, itraconazole, and fluconazole. We describe the first case of an E. oligosperma induced soft-tissue infection successfully treated with a 3-month course of voriconazole without persisting lesions.
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Affiliation(s)
- Bassam H Rimawi
- Medical University of South Carolina, Charleston, SC 29414, USA
| | - Ramzy H Rimawi
- Brody School of Medicine - East Carolina University, Greenville, NC 27834, USA
| | - Meena Mirdamadi
- Medical University of South Carolina, Charleston, SC 29414, USA
| | - Lisa L Steed
- Medical University of South Carolina, Charleston, SC 29414, USA
| | | | - Deanna A Sutton
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Elizabeth H Thompson
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Nathan P Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Jonathan R Lindner
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - M Sean Boger
- Medical University of South Carolina, Charleston, SC 29414, USA
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Reflections on the approach to treatment of a mycologic disaster. Antimicrob Agents Chemother 2013; 57:1567-72. [PMID: 23384533 DOI: 10.1128/aac.02242-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Suzuki K, Nakamura A, Fujieda A, Nakase K, Katayama N. Pulmonary infection caused by Exophiala dermatitidis in a patient with multiple myeloma: A case report and a review of the literature. Med Mycol Case Rep 2012; 1:95-8. [PMID: 24371750 DOI: 10.1016/j.mmcr.2012.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022] Open
Abstract
Exophiala dermatitidis is a dematiaceous fungus that is increasingly being identified as a cause of fungal infection especially in patients with immunodeficiency. To date, however, the factors predisposing E. dermatitidis and its optimal treatments have not been fully addressed. Here, we report the first patient with untreated multiple myeloma who developed E. dermatitidis pulmonary infection. We also review recent clinical reports describing the features of E. dermatitidis infection.
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Affiliation(s)
- Kei Suzuki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akiko Nakamura
- Central Clinical Laboratories, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsushi Fujieda
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kazunori Nakase
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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