A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure
Background: Lung infection by Scedosporium apiospermum in immunocompetent individuals is very rare. Case Report: We present a unique case of mediastinal granulomatous inflammatory lymphadenopathy in a diabetic and cirrhotic individual with a history of significant exposure to airborne fungus. Result...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Clinical Infection in Practice |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S259017022300033X |
| _version_ | 1797277262373978112 |
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| author | Flora Hay Katherine Hill Michiala Jaye Cafferkey Iain Page Andrew Wood Tracie Plant |
| author_facet | Flora Hay Katherine Hill Michiala Jaye Cafferkey Iain Page Andrew Wood Tracie Plant |
| author_sort | Flora Hay |
| collection | DOAJ |
| description | Background: Lung infection by Scedosporium apiospermum in immunocompetent individuals is very rare. Case Report: We present a unique case of mediastinal granulomatous inflammatory lymphadenopathy in a diabetic and cirrhotic individual with a history of significant exposure to airborne fungus. Results: The patient underwent a computed tomography pulmonary angiogram to investigate for pulmonary embolus, which showed multiple enlarged mediastinal and hilar lymph nodes with punctate calcification and small lung nodules in both lungs. The patient had mild symptoms of a cough productive of clear-green sputum. Endobronchial ultrasound bronchoscopy fluid from the subcarinal lymph node and fine needle aspiration tissue both isolated a mould identified as Scedosporium apiospermum. As the patient was stable, symptomatic and radiological monitoring was pursued in the first instance. Interval imaging showed no change in the lymphadenopathy or lung nodules at three months. Conclusion: The mediastinal granulomatous lymphadenopathy in this case could represent a successful attempt by the patient’s innate immune response to control the infection and prevent invasive spread. It could also represent sarcoidosis secondary to fungal exposure. This pattern of disease for Scedosporium apiospermum is previously unreported. |
| first_indexed | 2024-03-07T15:46:07Z |
| format | Article |
| id | doaj.art-0d79e2c01258467cb16ce8db10c26f46 |
| institution | Directory Open Access Journal |
| issn | 2590-1702 |
| language | English |
| last_indexed | 2024-03-07T15:46:07Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj.art-0d79e2c01258467cb16ce8db10c26f462024-03-05T04:30:49ZengElsevierClinical Infection in Practice2590-17022024-01-0121100250A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposureFlora Hay0Katherine Hill1Michiala Jaye Cafferkey2Iain Page3Andrew Wood4Tracie Plant5Acute Medicine Core Trainee, NHS Lothian, St John’s Hospital, Howden Road West, Howden, Livingston, Scotland, EH54 6PP, United Kingdom; Corresponding author at: 28 Spottiswoode Street, Marchmont, Edinburgh EH9 1DG, United Kingdom.Infectious Diseases & Medical Microbiology Registrar, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, Scotland, EH4 2XU, United KingdomRespiratory Registrar, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, Scotland, EH4 2XU, United KingdomInfectious Diseases Consultant, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, Scotland, EH4 2XU, United KingdomHistopathology Consultant, NHS Lothian, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland, EH16 4SA, United KingdomRespiratory Consultant, NHS Lothian, St John’s Hospital, Howden Road West, Howden, Livingston, Scotland, EH54 6PP, United KingdomBackground: Lung infection by Scedosporium apiospermum in immunocompetent individuals is very rare. Case Report: We present a unique case of mediastinal granulomatous inflammatory lymphadenopathy in a diabetic and cirrhotic individual with a history of significant exposure to airborne fungus. Results: The patient underwent a computed tomography pulmonary angiogram to investigate for pulmonary embolus, which showed multiple enlarged mediastinal and hilar lymph nodes with punctate calcification and small lung nodules in both lungs. The patient had mild symptoms of a cough productive of clear-green sputum. Endobronchial ultrasound bronchoscopy fluid from the subcarinal lymph node and fine needle aspiration tissue both isolated a mould identified as Scedosporium apiospermum. As the patient was stable, symptomatic and radiological monitoring was pursued in the first instance. Interval imaging showed no change in the lymphadenopathy or lung nodules at three months. Conclusion: The mediastinal granulomatous lymphadenopathy in this case could represent a successful attempt by the patient’s innate immune response to control the infection and prevent invasive spread. It could also represent sarcoidosis secondary to fungal exposure. This pattern of disease for Scedosporium apiospermum is previously unreported.http://www.sciencedirect.com/science/article/pii/S259017022300033X |
| spellingShingle | Flora Hay Katherine Hill Michiala Jaye Cafferkey Iain Page Andrew Wood Tracie Plant A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure Clinical Infection in Practice |
| title | A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure |
| title_full | A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure |
| title_fullStr | A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure |
| title_full_unstemmed | A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure |
| title_short | A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure |
| title_sort | case of mediastinal granulomatous lymphadenopathy following significant scedosporium apiospermum exposure |
| url | http://www.sciencedirect.com/science/article/pii/S259017022300033X |
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