Systemic Scedosporium apiospermum Infection Affecting Multiple Sites After Near-Drowning: A Case Report

Area of Science:

• Medical Mycology
• Infectious Diseases

Background:

• Scedosporium apiospermum (S. apiospermum) is an opportunistic fungal pathogen.
• Near-drowning incidents, particularly in contaminated water, pose a risk for S. apiospermum infections.
• Bone and joint infections caused by S. apiospermum are uncommon but can be severe.

Observation:

• A 35-year-old female developed aspiration pneumonia and knee arthritis after a near-drowning incident in sewage.
• Macrogenomic sequencing of synovial fluid identified S. apiospermum.
• Despite initial voriconazole treatment, new lesions appeared in the hip and spine.

Findings:

• S. apiospermum demonstrated aggressive invasiveness and widespread dissemination in the patient.
• Combined therapy with voriconazole and amphotericin B cholesterol sulfate lipid complex for 30 days led to significant symptom improvement.

Implications:

• This case underscores the potential for S. apiospermum to cause extensive osteoarticular infections.
• Prompt diagnosis using advanced techniques like macrogenomic sequencing is crucial.
• A combination antifungal approach may be a safe and effective strategy for managing invasive S. apiospermum infections.