Department of Molecular Imaging and Therapy, Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, California, USA.
Division of Infectious Diseases, City of Hope, Duarte, California, USA.
Clin Infect Dis. 2021 Apr 26;72(8):1386-1391. doi: 10.1093/cid/ciaa231.
The toxigenic mold Stachybotrys has controversially been linked to idiopathic pulmonary hemorrhage and "sick building syndrome." However, there are no previous clinical records of invasive stachybotryosis.
Sinus biopsy specimens from a 23-year-old male with refractory acute lymphocytic leukemia were obtained at 3 different time points during the patient's hospitalization (139 days) and examined by histopathology and immunohistochemistry (IHC). Antifungal susceptibility testing and fungal speciation using multilocus sequence typing were performed.
Hemorrhage, fungal germination, and hyphal growth were observed in the first sinus biopsy tissues. Areas with fungal growth tested positive for Stachybotrys by IHC. Fungal isolates were genotyped and identified as Stachybotrys chlorohalonata. The patient was cured from Stachybotrys sinusitis following sinus surgery and antifungal treatment. While a subsequent second sinus biopsy and a bronchoscopy showed no signs of fungal infection, a later, third sinus biopsy tested positive for Aspergillus calidoustus, a rare human pathogen.
Here, we report the first case of invasive S. chlorohalonata sinusitis that was surgically and medically cured but followed by invasive A. calidoustus sinusitis in the setting of refractory leukemia. Our findings emphasize the risk for unusual fungal infections in severely immunocompromised patients.
产毒霉菌拟青霉曾有争议地与特发性肺出血和“病态建筑综合征”有关。然而，此前并无侵袭性拟青霉病的临床记录。
对一名 23 岁患有难治性急性淋巴细胞白血病的男性患者，在住院期间（139 天）的 3 个不同时间点，进行鼻窦活检，并通过组织病理学和免疫组织化学（IHC）进行检查。进行了抗真菌药敏试验和使用多位点序列分型的真菌种鉴定。
首次鼻窦活检组织中观察到出血、真菌发芽和菌丝生长。真菌生长区域通过 IHC 检测呈拟青霉阳性。真菌分离株经基因分型并鉴定为拟青霉chlorohalonata。在鼻窦手术后和抗真菌治疗后，患者的拟青霉性鼻窦炎被治愈。虽然随后的第二次鼻窦活检和支气管镜检查未显示真菌感染的迹象，但后来的第三次鼻窦活检检测出了罕见的人类病原体棘孢曲霉。
本研究报告了首例侵袭性拟青霉 chlorohalonata 鼻窦炎病例，该病例经手术和药物治愈，但在难治性白血病的背景下，随后发生了侵袭性棘孢曲霉鼻窦炎。我们的研究结果强调了严重免疫功能低下患者发生不常见真菌感染的风险。
