Pulmonary phaehyphomycosis in retroviral disease patient

• Main Authors: Zainulabid, Ummu Afeera, Abdul Azih, Muhammad Naimmuddin, Maniyam, Sasi Kumar, Abd. Fuaat, Azliana, Abidin, Mohd Radhwan, Ahmad, Hajar Fauzan
• Format: Article
• Language: English
• Published: Federation of Islamic Medical Associations (FIMA) 2021
• Subjects: RC Internal medicine; RC111 Infectious and Parasitic Diseases
• Online Access: http://irep.iium.edu.my/92609/7/92609%20Pulmonary%20Phaehyphomycosis%20in%20Retroviral%20Disease%20Patient.pdf; http://irep.iium.edu.my/92609/; https://ijhhsfimaweb.info/index.php/IJHHS/article/view/335

Pulmonary phaeohyphomycosis is a rare infection in the lung caused by black fungi containing a cytoplasmic melanin-like pigment. A 42-year-old man with underlying retroviral disease on HAART was investigated for having constitutional symptoms. Despite undetectable viral load and a high CD4 count, he was found to have unexplained significant loss of weight and appetite over a period of 6 months. Clinical examination revealed a cachexic man with multiple inguinal lymphadenopathies. Excisional biopsy of the inguinal lymph node revealed reactive follicular hyperplasia. CT Thorax, Abdomen and Pelvis was arranged to look for occult malignancy or infection and he was found to have multiple non-enhancing subcentimeter lung nodules mainly at the lateral segment of the right middle lobe of his lung. The largest nodule measured about 0.8 x 1.5 x 0.5 (AP x W x CC), with some nodules having an irregular margin with no extension into the adjacent bronchi. Bronchoscopy was done and demonstrated a black patch at the right intermedius, lateral segment of the middle lobe which did not disappear upon bronchial flush or wash. Histopathological examination found focal areas of blackish pigment and the bronchial alveolar lavage sent for fungal culture grew Cladosporium species. The patient was treated with oral Itraconazole with marked clinical improvement. This case highlights an unusual black fungi infection in the lung that stands out not only for its rarity and it's responsiveness to treatment, but also the susceptibility of an RVD positive patient to this infection despite having suppressed viral load and normal CD4 count.