B72-39 Silent Spores, Sudden Storm: Scedosporium, the Imposterous Inhalant

Abstract Introduction Scedosporium sp. are a rare but potentially severe cause of pulmonary infections, with mortality rates up to 90%. While typically identified in immunocompromised patients, Scedosporium infections can also affect immunocompetent patients. Scedosporium infections are of particular interest due to high mortality rates from intrinsic resistance to first line antifungals. In this case, we describe a patient who developed pulmonary scedosporiosis. Case Presentation An 88-year old man with bronchiectasis and chronic steroid use presented with shortness of breath, hypoxemia, unintentional weight loss, and cough with yellow sputum. CT chest revealed a right lower lobe cavitary consolidation not seen on a CT scan 3 months prior. Initially, a diagnosis of CAP was suspected. A bronchoalveolar lavage indicated fungal growth however Aspergillus, Cryptococcus, and pneumoconiosis serologies were negative. He was treated empirically for fungal pneumonia with Itraconazole until fungal growth speciated, showing Scedosporium spp. Antifungal therapy was then transitioned to Voriconazole with subsequent clinical improvement. Discussion Scedosporium is not a common cause of fungal pneumonia and carries a high intrinsic resistance to first-line antifungals. Diagnosis can be difficult if relying solely on histopathology due to fungal morphology overlap with other hyaline molds. New nucleic acid sequencing can help differentiate the species, however, fungal specimen cultures remain the preferred method for diagnosis. Structural lung disease and immunocompromised status from steroid use were the risk factors allowing for opportunistic infection in our patient. Fortunately, he improved with pharmacotherapy alone, whereas surgical intervention may be utilized for refractory cases. Conclusion Scedosporium rarely causes pulmonary infections, especially cavitary pneumonia. Delayed diagnosis or inadequate treatment contribute to its high mortality rate, most notably with immunocompromised hosts. The first-line treatment regimen consists of Voriconazole but additional work has been done hypothesizing multi-drug regimens. Surgical evaluation may be considered in select cases refractory to medical therapy alone. In vulnerable patients with respiratory symptoms and radiographic consolidations, early consideration of fungal pathogens, such as Scedosporium, can ensure correct therapy is initiated which is essential to achieving favorable outcomes. This abstract is funded by: None