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면역기능이 정상인 성인 여성에서 Schizophyllum commune에 의해 발생한 기관지확장증 1예
A Rare Case of Bronchiectasis with Mucoid Impaction Caused by Schizophyllum commune in an Immunocompetent Woman in South Korea
성균관대학교 강북삼성병원 진단검사의학과1, 호흡기내과2, 병리과3, 영상의학과4
Department of Laboratory Medicine1, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; Division of Pulmonary and Critical Care Medicine2, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; Department of Pathology3, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; Department of Radiology4, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to:This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lab Med Online 2023; 13(1): 27-30
Published January 1, 2023 https://doi.org/10.47429/lmo.2023.13.1.27
Copyright © The Korean Society for Laboratory Medicine.
Keywords
A 52-year-old female patient was referred to our institution from a local clinic for further examination of suspected bronchitis. The patient had symptoms of cough, whitish sputum, and chest discomfort lasting approximately one month. The patient was a non-smoker and had no medical history of pulmonary tuberculosis, asthma, rhinitis, diabetes, hypertension, allergy, or gastroesophageal reflux disease. She was not receiving any medical treatments. Her occupation was a shoe vendor, and her family history included her brother’s lung cancer. The patient’s body temperature was 36.9°C, and her respiratory examination was normal, without wheez-ing. Upon laboratory investigation, white blood cell count was 5,490/µL with 373/µL eosinophils. Serum C-reactive protein levels were elevated to 1.35 (reference range <0.6), and total IgE was 216 kU/µL (<100). The culture and smear of a series of three sputum specimens and a serum aspergillus antibody test were all negative. Posteroanterior chest radiography revealed a mass-like consolidation in the right lower lobe. Mucoid impaction manifested as high-density beaded lesions in the right middle lobe (RML) and atelectasis of RML on pre-contrast axial CT scan. A bronchoscopic examination revealed thick yellowish mucoid impaction with total obstruction of the RML bronchus (Fig. 1).
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Figure 1. (A) Postero-anterior X-ray revealed a mass-like consolidation in the right lower lung field (red arrow). (B) Mucoid impaction manifested as a high density on pre-contrast CT scan (yellow arrow). (C) The bronchoscopic examination showed thick yellowish mucoid impaction with total obstruction of the right middle lobe bronchus (blue arrow).
Histopathological examination with Gomori’s methenamine silver (GMS) staining on a prepared paraffin block revealed a few scattered degenerated fungal hyphae. Bronchoscopic aspirate specimens were plated as a fungal culture on Sabouraud dextrose agar and incubated at 36.5°C for 24 hours and then at 25°C for three days, showing dense, fine, soft, hair-like white mycelial growth, defined as fungal hyphae under GMS staining. Microscopic examination revealed several thin hyaline hyphal filaments without clamp connections or spicules (Fig. 2).
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Figure 2. (A) Gomori’s methenamine silver (GMS) stain of a prepared paraffin block revealed fungal hyphae (GMS stain, ×200). (B) White, woolly colonies grew on Sabouraud dextrose agar after incubation of bronchoscopic aspirate specimens for 3 days. (C) GMS stain revealed several thin hyaline hyphal filaments without clamp connections or spicules on microscopic examination (GMS stain, ×400). (D) The red arrow indicates the narrower width hyphae, and the black arrow indicates the wider hyphae (lactophenol cotton blue stain, ×400).
We performed molecular identification by DNA amplification and sequencing analysis of the Internal Transcribed Spacer (ITS) gene to identify the fungus. The primer pair used for amplifying ITS sequencing was ITS1 (5′-TCC GTA GGT GAA CT GCG G-3′) and ITS4 (5′ TCC TCC GCT TAT TCA TAT GC-3′). We used the basic local alignment search tool (BLAST) of the GenBank (http://blast.ncbi.nlm.nih.gov/) database to analyze the sequencing results. Comparative analysis of the partial ITS sequence demonstrated 100% identity with
The patient was diagnosed with bronchiectasis with mucoid impaction caused by
The rate of human infections caused by
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Table 1 . Literature review of
Schizophyllum commune invasive infection in immunocompetent patientsNo. Sex/Age (yr) Diagnosis Confirmation method Treatment Outcome Country, Year [Reference] 1 M/58 Several lung and brain abscesses Histologic finding Amphotericin B deoxycholate and itraconazole Died The USA, 1996 [4] 2 M/53 Epidural abscess Sequence analysis Vancomycin, meropenem, and liposomal amphotericin B Cured Japan, 2018 [5] 3, 4, 5 F/45, F/37, F/30 Rhinosinusitis with mucosal and/or bone invasion MALDI-TOF MASS spectrometry and sequence analysis Surgery and voriconazole Cured France, 2015 [6] 6 M/56 Bronchogenic cyst Sequence analysis Surgery Cured Serbia, 2006 [7] 7 F/30 Sino-orbital infection Sequence analysis Amphotericin B deoxycholate and voriconazole Cured Korea, 2012 [11] 8 F/54 Mucoid impaction of the bronchi Histologic finding Itraconazole Cured Japan, 2007 [14] 9 F/50 Sino-orbital infection Cycloheximide susceptibility (400 µg/mL) and tolerance to benomyl (10 µg/mL) Surgery and amphotericin B deoxycholate Cured India, 2020 [15] 10 F/59 Pulmonary mycosis Sequence analysis Voriconazole and pulmicort inhalation Cured China, 2016 [16]
In Korea, several cases of
Conflicts of Interest
None declared.
- Hibbett DS, Binder M, Bischoff JF, Blackwell M, Cannon PF, Eriksson OE, et al. A higher-level phylogenetic classification of the Fungi. Mycol Res 2007;111:509-47.
- Chowdhary A, Kathuria S, Agarwal K, Meis JF. Recognizing filamentous basidiomycetes as agents of human disease: a review. Med Mycol 2014;52:782-97.
- Chowdhary A, Randhawa HS, Gaur SN, Agarwal K, Kathuria S, Roy P, et al.
Schizophyllum commune as an emerging fungal pathogen: a review and report of two cases. Mycoses 2013;56:1-10. - Rihs JD, Padhye AA, Good CB. Brain abscess caused by
Schizophyllum commune : an emerging basidiomycete pathogen. J Clin Microbiol 1996;34:1628-32. - Tone K, Fujisaki R, Hagiwara S, Tamura T, Ishigaki S, Alshahni MM, et al. Epidural abscess caused by
Schizophyllum commune : A rare case of rhinogenic cranial complication by a filamentous basidiomycete. Mycoses 2018;61:213-7. - Michel J, Maubon D, Varoquaux DA, Boulze C, Normand AC, Righini CA, et al.
Schizophyllum commune : an emergent or misdiagnosed fungal pathogen in rhinology? Med Mycol 2016;54:301-9. - Bulajic N, Cvijanovic V, Vukojevic J, Tomic D, Johnson E.
Schizophyllum commune associated with bronchogenous cyst. Mycoses 2006;49:343-5. - Kim H, Yi Y, Cho SY, Lee DG, Chun HS, Park C, et al. Pneumonia due to
Schizophyllum commune in a patient with acute myeloid leukemia: Case report and literature review. Infect Chemother 2022;54:195-201. - Lee JM, Han E, Kim J, Park JH, Sung GH, Shin JH, et al. Five Korean cases of respiratory tract infection by filamentous basidiomycetes. Ann Lab Med 2020;40:84-7.
- Won EJ, Shin JH, Lim SC, Shin MG, Suh SP, Ryang DW. Molecular identification of
Schizophyllum commune as a cause of allergic fungal sinusitis. Ann Lab Med 2012;32:375-9. - Sa HS, Ko KS, Woo KI, Peck KR, Kim YD. A case of sino-orbital infection caused by the
Schizophyllum commune . Diagn Microbiol Infect Dis 2012;73:376-7. - Cavanna C, Pagella F, Esposto MC, Tamarozzi F, Clemente L, Marone P, et al. Human infections due to
Schizophyllum commune : case report and review of the literature. J Mycol Med 2019;29:365-71. - Brandt ME. Filamentous basidiomycetes in the clinical laboratory. Curr Fungal Infect Rep 2013;7:219-23.
- Ishiguro T, Takayanagi N, Tokunaga D, Kurashima K, Matsushita A, Harasawa K, et al. Pulmonary
Schizophyllum commune infection developing mucoid impaction of the bronchi. Yale J Biol Med 2007;80:105-11. - Kaur M, Chander J, Singla N, Das A, Sood S, Guarro J. Sino-orbital infection caused by
Schizophyllum commune -rare presentation of a basidiomycetous fungus. J Mycol Med 2020;30:100934. - Shen Q, Yao YK, Yang Q, Zhou JY.
Schizophyllum commune -induced pulmonary mycosis. Chin Med J (Engl) 2016;129:2141-2. - González GM, Sutton DA, Thompson E, Tijerina R, Rinaldi MG. In vitro activities of approved and investigational antifungal agents against 44 clinical isolates of basidiomycetous fungi. Antimicrob Agents Chemother 2001;45:633-5.