Expanding Epidemiology: A Case of Pulmonary Disease Caused by Acrophialophora angustiphialis

A 61-year-old woman presented with progressive shortness of breath, cough with expectoration, hemoptysis, and fever for 2 months. On admission, altered parameters included low oxygen saturation, slightly elevated total leukocyte count, and elevated bilirubin and liver enzymes. Contrast-enhanced computed tomography of the chest revealed bilateral cystic bronchiectasis with multiple cavitary nodules. Ultrasonography of the abdomen revealed extrahepatic biliary obstruction, likely carcinomatous in etiology. She was started on antibiotics and percutaneous transhepatic biliary drainage was done. The patient had to be intubated owing to worsening respiratory function. Antifungals were added subsequently due to raised galactomannan levels, but the patient died due to refractory hypokalemia. Postmortem lung biopsy sample showed septate hyphae on direct microscopy. The culture of the mini-bronchoalveolar lavage sample, as well as postmortem lung biopsy, grew a dematiaceous mold. Sequencing of the internal transcribed spacer region of the 18S ribosomal DNA identified the isolate to be Acrophialophora angustiphialis.