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A 45-year-old male, under treatment (Ara-C, 300 mg day -1 and daunomycin 270 mg day -t) for acute myeloid leukaemia was admitted to the hospital with pneumonia involving the lower lobe of the left lung and pleural effusion. Empiric antibiotic treatment was started with ceftazidime (8 g day-l), piperacillin 4 g day-1 and intravenous amikacin (1 g day 1) and vancomycin (2 g day 1). Nine days later, due to the lack of evident clinical improvement, amphotericin B (steady-state dose of 30 mg day -1) was added. At this time the patient (white blood cell count (WBC) = 1150) was suffering from renal damage and oliguria, and a bladder catheter was inserted. Ten days later the patient (WBC = 570) had recovered from the pneumonic episode but treatment was continued for a further 2 weeks. During this period the patient complained of urethral discomfort and 2 days after discontinuation of therapy (WBC = 4770), the patient referred to a more intense urethral pain, which was accompanied by a leukocyte discharge in the urethra and urine. Urine culture on Sabouraud glucose agar containing chloramphenicol (0.5 g I 1) and Columbia-blood agar, revealed the presence, after 48 h at 37°C, of a heavy growth (more than 100 000 colony forming units (CFU) of a fluffy white fungus. No other bacterial or fungal pathogens were recovered. The bladder catheter was then removed. Fresh sediment from a centrifuged urine specimen obtained the following day was stained with lactophenol cotton blue and septate hyphae were observed. Urethral swab culture yielded an identical fungus to the urine. After 4-5 days, single-celled, thin walled, pear-like conidia developed (colonies were mousy brown-grey at this time). The development on corn-meal agar of elongate synnemata of Graphium type conidiation and the presence after four subcultures of brown and spherical cleistothecia served to confirm the identification of the isolate as Pseudallescheria boydii. Primary cultures on cycloheximide containing agar (0.5 g 1-1) yielded negative results. Five days after the first isolation, P boydii was again isolated from a urethral swab specimen and from urine at a much lower density (10 000 CFU ml-1). Two weeks later, despite the absence of specific treatment, culture was negative. The same result was obtained in further controls, but the patient developed a severe Gram negative bacteraemia involving Enterobacter cloacae and Klebsiella oxytoca. A particulate antigen was prepared by culturing P. boydii for 5 days in Sabouraud glucose broth at 37°C. Thirty millilitres of culture was centrifuged at 3500 rev. min-1 'for 30 min, and the fungal pellet was washed in distilled water, diluted 1:1000 and 20 smears 79 Med Mycol Downloaded from informahealthcare.com by Mcgill University on 11/27/14For personal use only.

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