A case of mediastinal granulomatous lymphadenopathy following significant Scedosporium apiospermum exposure

Lung infection by Scedosporium apiospermum in immunocompetent individuals is very rare. We present a unique case of mediastinal granulomatous inflammatory lymphadenopathy in a diabetic and cirrhotic individual with a history of significant exposure to airborne fungus. The patient underwent a computed tomography pulmonary angiogram to investigate for pulmonary embolus, which showed multiple enlarged mediastinal and hilar lymph nodes with punctate calcification and small lung nodules in both lungs. The patient had mild symptoms of a cough productive of clear-green sputum. Endobronchial ultrasound bronchoscopy fluid from the subcarinal lymph node and fine needle aspiration tissue both isolated a mould identified as Scedosporium apiospermum. As the patient was stable, symptomatic and radiological monitoring was pursued in the first instance. Interval imaging showed no change in the lymphadenopathy or lung nodules at three months. The mediastinal granulomatous lymphadenopathy in this case could represent a successful attempt by the patient’s innate immune response to control the infection and prevent invasive spread. It could also represent sarcoidosis secondary to fungal exposure. This pattern of disease for Scedosporium apiospermum is previously unreported.