Co‐infection of Scedosporium apiospermum and Mycobacterium chelonae in an immunocompetent host

Abstract

A 75-year-old man presented with multiple, scaly, erythematous, grouped papules, nodules and plaques with tenderness ranging from the right forearm to hand dorsum and the right lower leg for 2-3 months. Five months prior to presentation, the patient had received an antibiotic skin test on his right forearm. Lesions appeared approximately 2-3 months after the antibiotic skin test, slowly progressing without clinical improvement. Culture for fungus on the right forearm revealed growth of Scedosporium apiospermum. The tissue acid-fast bacilli (AFB) culture for the right forearm and right leg revealed growth of non-tuberculous mycobacteria which was Mycobacterium chelonae, and subsequent tissue polymerase chain reaction of both sites reported positive signs of M. chelonae. On diastase periodic acid-Schiff stain of the biopsy specimen of the right forearm, fungal hyphae were found while rod-shaped bacilli could be seen in AFB stain for the biopsy specimen of the right leg. The patient was treated with oral clarithromycin and ciprofloxacin along with an oral antifungal agent for 13 weeks. After the treatment, the lesions subsided and left a scar. We report a rare case of co-infection of S. apiospermum and M. chelonae in an immunocompetent host.

Pneumonia caused by Scedosporium in non-Transplant and non-HIV-infected adults：A case series and review of the literature

“…Both of them were mixed infection cases. Until now, only three mixed pulmonary infection cases of Scedosporium and nontuberculous mycobacteria was reported 15,20,21 . Two patients had a history of pulmonary tuberculosis and one had a 15-year history of nontuberculous mycobacteria (NTM) pneumonia.…”

“…No guideline recommendation could be given because no antifungal susceptibility testing results were available for the second patient. In the cases of pulmonary nontuberculous mycobacterial and Sedosporiumcoinfection 15,20,21 , only one patient who had no indication for surgery was treated with voriconazole alone for 6-month with initial dose of 400 mg daily, then increased to 500 mg daily based on TDM results. The symptoms and imaging improved after 6 months, but no follow-up records were reported.…”

Histopathological clues in the diagnosis of fungal infection by Scedosporium in a case of endophthalmitis starting as conjunctivitis

“…Some of them have been described in immunocompetent individuals . Typical characteristic hyphae are shown in the figures presented in some of the reports of cutaneous cases . Some of the articles just mention the ‘45°‐’ or the ‘acute angle‐’ branching patterns of the fungus.…”

Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients

“…isolation in patients' samples. The case reports describe infection cases [116][117][118][119][120][121][122][123][124][125][126], but for several prospective and retrospective studies either it is not clear, or both infection and colonization are present [71,120,[127][128][129][130][131][132]. There is evidence that coinfection by fungal and mycobacterial spp.…”

“…MAC (M. avium and M. intracellulare) and MABC (M. abscessus and M. massiliense) were considered more prone to cause infection, whereas M. chelonae, M. gordonae and M. fortuitum were more likely to be regarded as colonizers [71]. Curiously, a coinfection by M. chelonae and Scedosporium apiospermum was reported in an immunocompetent individual [126]. The patient had a history of diabetes (a predisposing condition for NTM infection) and hyperlipidemia controlled by medication and, after a skin antibiotic test as part of a prechirurgical procedure, presented skin lesions compatible with an infectious process.…”