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Paecilomyces lilacinus olecranon bursitis in an immunocompromised host: case report and review
Mireya Wessolossky1, John P Haran, Kaushik Bagchi
1Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Abstract:
Paecilomyces lilacinus is a little-known mold that causes rare cases of invasive infections in humans regardless of their immune status. We present a unique case in an immunocompromised host with olecranon bursitis because of multidrug-resistant P. lilacinus treated with systemic ketoconazole therapy and surgical debridement. Recognition of this fungus is difficult initially because of its appearance, which can be confused with that of other fungi. Once this organism has been identified, it is recommended that antifungal susceptibility testing be obtained to guide appropriate therapy. Combination of therapeutic modalities requires case-by-case assessment. Surgical debridement and removal of prosthesis may be indicated. Although P. lilacinus can be a laboratory contaminant, in our case, causation was established as the organism grew in repeated cultures, sufficient to confirm a fungal origin for his bursitis.
Insights
This study details a rare invasive infection caused by Paecilomyces lilacinus in an immunocompromised patient. Effective treatment involved ketoconazole and surgical debridement for multidrug-resistant fungal bursitis.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- Paecilomyces lilacinus is an infrequently encountered mold capable of causing invasive human infections.
- Infections can occur in individuals irrespective of their immune status.
- Accurate identification of P. lilacinus can be challenging due to its morphological resemblance to other fungi.
Observation:
- A unique case of olecranon bursitis caused by multidrug-resistant Paecilomyces lilacinus in an immunocompromised host is presented.
- Initial presentation mimicked other fungal infections, complicating early diagnosis.
- Repeated fungal cultures confirmed P. lilacinus as the causative agent of the bursitis, ruling out laboratory contamination.
Findings:
- Successful treatment was achieved through a combination of systemic ketoconazole therapy and surgical debridement.
- Antifungal susceptibility testing is crucial for guiding appropriate therapeutic strategies against P. lilacinus.
- The management of P. lilacinus infections necessitates a tailored, case-by-case approach.
Implications:
- This case highlights the importance of considering P. lilacinus in the differential diagnosis of invasive fungal infections, particularly in immunocompromised patients.
- Prompt and accurate identification, coupled with susceptibility testing, is vital for effective treatment.
- Combined therapeutic modalities, including surgical intervention, may be required for successful outcomes in complex cases.
