Chronic pulmonary aspergillosis due to Aspergillus nomius in a patient with disseminated phaeohyphomycosis resistant to antifungal drugs

Abstract

The aim of this presentation is to present the clinical, mycological and histopathological findings of a case of chronic pulmonary aspergillosis due to Aspergillus nomius, in a 52 year old woman, who suffers from disseminated phaeohyphomycosis with cutaneous, ganglionary and bone lesions due to Exophiala spinifera with 22 years of evolution. This pulmonary aspergillosis presented clinically
as a chronic pneumonia of the middle lobe of the right lung, which evolved toward excavation and the production of a chronic lung abscess. This mycosis appeared during posaconazole treatment, at a daily dose of 800 mg, and the infection presented a good clinical response to intravenous caspofungin. The patient was submitted to surgical remotion of middle and lower lobes of the right lung. Histopathological study of the surgical sample showed Aspergillus nomius invasion of blood vessels and the production of an epithelioid granuloma with giant cells around the endovascular hyphae. The etiologic agent of this aspergillosis was also isolated from several sputum and bronchoalveolar lavage samples and its identification as Aspergillus nomius was done by molecular biology studies. We were not able to establish a clear cause of immunodeficiency.