Fatal pulmonary Scedosporium aurantiacum infection in a patient after near-drowning: A case report

Background and Purpose: Scedosporium spp. is a saprophytic fungus that may cause invasive pulmonary infection due to the aspiration of contaminated water in both immunosuppressed and immunocompetent hosts.Case report: Herein, we report a fatal case of pulmonary infection caused by Scedosporium species associated with a car crash and near-drowning in a sewage canal.Scedosporium aurantiacum isolated from bronchoalveolar lavage was identified by PCR-sequencing of β-tubulin genes. The minimum inhibitory concentration values for amphotericin B, itraconazole, posaconazole, isavuconazole were >۱۶ µg/ml, and >۸ µg/ml for anidulafungin, micafungin, and caspofungin. Voriconazole was found to be the most active agent with a MIC of ۱ µg/ml.Conclusion: This report, as the first case of pulmonary scedosporiosis after near-drowningin Iran, highlights the importance of high suspicion in near-drowning victims, promptidentification of Scedosporium spp., and early initiation of appropriate antifungal therapy.

Keywords:

Antifungal susceptibility test , Amphotericin B , invasive pulmonary infection , near-drowning , Scedosporium aurantiacum , voriconazole