SHM Converge Scientific Abstract ePoster Gallery-Hemoptysis: Not a Fun(gi) Time

Pdf Summary

This case describes a 56-year-old woman with a history of acute myeloid leukemia status post allogenic stem cell transplant, chronic graft-versus-host disease on mycophenolate, and prior pulmonary coccidioidomycosis who presented with 7 days of hemoptysis and upper respiratory symptoms. Initial workup showed elevated D-dimer and chest CT angiogram negative for pulmonary embolism but revealing a chronic nodular lesion in the left upper lobe with distal bronchiectasis and mucus plugging, present since at least 2016. Bronchoscopy identified an endobronchial lesion with green necrotic debris.<br /><br />Laboratory testing showed marked eosinophilia, raising suspicion for fungal infection. Bronchoscopic biopsy demonstrated mycetoma, and fungal culture grew Scedosporium species complex. Aspergillus antigen testing from serum and bronchoalveolar lavage was negative, as were Blastomyces, Histoplasma, and Coccidioides studies.<br /><br />The patient was treated with voriconazole, the recommended first-line therapy for Scedosporium infection, along with 5 days of cefepime for possible superimposed bacterial infection. Surgery was not performed. Her cough and hemoptysis resolved within three weeks, and follow-up CT showed interval reduction in the lesion. The plan was to continue voriconazole for at least 6 months.<br /><br />The key teaching point is that in patients with hemoptysis and marked eosinophilia, fungal infection should be strongly considered. Even when aspergillosis seems likely based on imaging or pathology, fungal culture is important to identify Scedosporium, especially in immunosuppressed patients, though it can also occur in immunocompetent hosts. Scedosporium can mimic aspergillosis clinically and radiographically, and correct identification is essential because treatment differs.

Asset Subtitle

Deandra K. Chetram

Meta Tag

Author List Deandra K. Chetram, Megan Dulohery Schrodin, Paschalis Vergidis, Sehrish Sardar, Supavit Chesdachai

Category Clinical Vignettes

Concept Scedosporium

Concept Pulmonary Scedosporiosis

Concept Voriconazole

Concept Fungal infection

Concept Fungal Culture

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester

Presenting Author Deandra K. Chetram

Track Adult

Keywords

hemoptysis

eosinophilia

Scedosporium

mycetoma

voriconazole

fungal infection

bronchoscopy

immunosuppressed

allogeneic stem cell transplant

aspergillosis mimic

Scedosporium

Pulmonary Scedosporiosis

Voriconazole

Fungal infection

Fungal Culture