Pulmonary Verruconis Infection in an Immunocompetent Patient: A Case Report and Literature Review

Verruconis species are thermophilic, darkly pigmented fungi commonly found in hot environments. Despite their environmental ubiquity, fewer than fifty human infections have been reported, with V. gallopava responsible for most cases. While infections primarily occur in immunocompromised individuals, only six cases in immunocompetent patients have been documented. We describe a case of pulmonary Verruconis infection in a 75-year-old immunocompetent woman. Despite broad-spectrum antifungal treatments, including liposomal amphotericin B and voriconazole, the patient's condition deteriorated. Bronchoalveolar lavage (BAL) revealed hyphal forms, and fungal culture identified a Verruconis species. Antifungal susceptibility tests showed low minimal inhibitory concentrations (MICs) for amphotericin B (1 μg/mL) and voriconazole (0.5 μg/mL). Clinical manifestations of Verruconis infection in immunocompetent pneumonia patients are non-specific. Structural lung disease was identified as the primary risk factor in such hosts. BAL fungal cultures and metagenomics are valuable tools in diagnosing rare fungal infections. Treatment regimens vary, with amphotericin B and triazoles being the most commonly used antifungal agents. Currently, there are no standardized guidelines for diagnosis or treatment. Further studies are needed to establish clinical protocols.