ABSTRACT
SESSION TITLE: Complicated Chest Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Fusarium species (FS) are large filamentous fungi widely distributed in soil and plants that are well-known to cause human infections ranging from superficial to disseminated predominantly depending on the host's immune system. Histoplasma capsulatum (HC), on the other hand, is a dimorphic fungus found in soil contaminated with bird or bat droppings, such as caves, where most infections are asymptomatic or self-limited. We present a case of an immunocompetent patient who developed long-term pulmonary sequelae after a co-infection pneumonia with FS and HC. CASE PRESENTATION: 47-year-old man, non-smoker with history of Myasthenia Gravis presents to the emergency department with worsening shortness of breath and sporadic episodes of fever over the course of 3 weeks. The patient claimed to have gone cave-exploring and worked as an air-condition technician. During the previous three years, he reports progressive dyspnea on exertion, fatigue, and a constant dry cough that required multiple hospitalizations which was treated as Myasthenic Crisis. Clinical exam was remarkable for diffuse rales on bilateral lungs with a resting hypoxia of 82-84%. Laboratories showed elevated inflammatory markers with no leukocytosis or neutropenia. Chest-x-ray revealed increased pulmonary markings and chest CT demonstrated diffuse bilateral ground-glass opacities with septal thickening and innumerable millimetric pulmonary nodules of unclear distribution. Extensive infectious, immunologic, and rheumatologic workup were negative. He underwent a bronchoscopy with broncho-alveolar lavage (BAL) which showed FS and HC on cytology. Therefore, intravenous liposomal Amphotericin B was given for 2 weeks followed by a long-course of oral Voriconazole resulting in marked improvement of symptoms, yet he remained with limited physical activity due to exertional hypoxia of less than 80%. Pulmonary function tests revealed mixed obstructive-restrictive disease. DISCUSSION: To our knowledge, this case represents a novel and rare presentation of invasive pulmonary fusariosis with superimposed histoplasmosis in an immunocompetent host. Our patient had environmental exposure for years with subsequent chronic and progressive respiratory symptoms, however, with no evidence of immunosuppression. Imaging findings were non-specific which difficulted the diagnosis. Nonetheless, the patient was given directed antifungal therapy as a result of the BAL's histopathologic findings with improvement of symptoms. CONCLUSIONS: Regardless of the immunologic status, invasive fungal pneumonia should be considered in patients with prolonged environmental exposure and non-specific chest imaging abnormalities. Reference #1: Chae, S. Y., Park, H. M., Oh, T. H., Lee, J. E., Lee, H., Jeong, W. G., & Kim, Y.-H. (2020). Fusarium species causing invasive fungal pneumonia in an immunocompetent patient: a case report. Journal of International Medical Research. https://doi.org/10.1177/0300060520976475. Retrieved March 18, 2022. Reference #2: Kauffman, C. A. (2022). Diagnosis and treatment of pulmonary histoplasmosis. In Bogorodskaya, M. (Ed.), UpToDate. Retrieved March 18, 2022, from https://www.uptodate.com/contents/diagnosis-and-treatment-of-pulmonary-histoplasmosis. Reference #3: Poignon, C., Blaize, M., Vezinet, C., Lampros, A., Monsel, A., & Fekkar, A. (2020). Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(11), 1582–1584. https://doi.org/10.1016/j.cmi.2020.06.026. Retrieved March 18, 2022. DISCLOSURES: No relevant relationships by Juan Adams-Chahin No relevant relationships by Jorge Barletta Farias No relevant relationships by Gabriel Galindez De Jesus No relevant relationships by Camille Gonzalez Morales No relevant relationships by manuel hernandez No rele ant relationships by Enrique Leal No relevant relationships by Arelis Morales Malavé No relevant relationships by Ruth Santos Rodriguez