Exophiala pneumonia requiring pneumonectomy in a post-renal transplant patient

Area of Science:

• Mycology
• Infectious Diseases
• Transplant Medicine

Background:

• Exophiala species are rare fungi capable of causing severe, life-threatening infections.
• Immunocompromised individuals, particularly transplant recipients with hematologic malignancies, are at high risk for invasive fungal infections.

Observation:

• A 55-year-old female post-renal transplant patient with active multiple myeloma presented with cough and dyspnea.
• Imaging revealed a cavitary lesion in the left upper lung lobe.
• Bronchoscopy confirmed invasive fungal infection by an Exophiala species.

Findings:

• The patient initially responded to antifungal therapy but experienced clinical deterioration.
• Invasive fungal infection progressed, necessitating a pneumonectomy.
• The patient developed a brain abscess secondary to the Exophiala infection.

Implications:

• This case underscores the diagnostic and therapeutic challenges posed by invasive Exophiala infections.
• Maintaining a broad differential diagnosis is crucial for immunocompromised patients presenting with pulmonary symptoms.
• Early and accurate identification of fungal pathogens is vital for effective management in high-risk populations.