Bertuccio Francesco Rocco, Baio Nicola, Montini Simone, Ferroni Valentina, Chino Vittorio, Pisanu Lucrezia, Russo Marianna, Giana Ilaria, Gallo Elisabetta, Arlando Lorenzo, Mucaj Klodjana, Tafa Mitela, Arminio Maria, De Stefano Emanuela, Cascina Alessandro, Corsico Angelo Guido, Stella Giulia Maria, Conio Valentina
Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.
Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy.
J Clin Med. 2025 Aug 21;14(16):5914. doi: 10.3390/jcm14165914.
is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic resistance to multiple antifungal agents. We report the case of a 66-year-old immunocompetent woman with idiopathic bilateral non-cystic fibrosis bronchiectasis, who presented with subacute cough and increased sputum production. Chest high-resolution CT revealed new subsolid and ground-glass infiltrates superimposed on stable bronchiectatic changes. Bronchoalveolar lavage (BAL) cultures isolated as the sole pathogen. The patient was treated with oral voriconazole (200 mg BID) for 4 weeks, followed by a 4-week course of aerosolized amphotericin B. Clinical and radiological improvement was observed, and no relapse occurred during follow-up. This case highlights the potential for to cause clinically relevant pulmonary infection in structurally abnormal but immunocompetent lungs. Non-CF bronchiectasis may facilitate fungal colonization due to impaired mucociliary clearance and chronic mucus retention. Combined antifungal therapy involving systemic voriconazole and inhaled amphotericin B (though not yet standardized) was employed based on clinical rationale and the available literature, resulting in favorable outcomes. pulmonary infection, although rare in immunocompetent hosts with bronchiectasis, should be considered in cases of new or persistent infiltrates. Early recognition and individualized antifungal strategies, including the potential role of inhaled agents, may improve clinical outcomes. This case reinforces the importance of multidisciplinary collaboration in the management of complex fungal infections in chronic airway disease.
是一种丝状真菌，越来越被认为是免疫功能低下宿主中的机会性病原体，尽管已有报道称在患有结构性肺病的免疫功能正常个体中也有罕见感染。由于其非特异性临床表现以及对多种抗真菌药物的固有耐药性，其诊断和治疗仍然具有挑战性。我们报告了一例66岁免疫功能正常的女性病例，她患有特发性双侧非囊性纤维化支气管扩张症，表现为亚急性咳嗽和痰量增加。胸部高分辨率CT显示在稳定的支气管扩张改变基础上出现了新的亚实性和磨玻璃样浸润影。支气管肺泡灌洗（BAL）培养分离出 作为唯一病原体。患者接受口服伏立康唑（200mg，每日两次）治疗4周，随后进行为期4周的雾化两性霉素B疗程。观察到临床和影像学改善，随访期间未复发。该病例突出了 在结构异常但免疫功能正常的肺部引起临床相关肺部感染的可能性。非囊性纤维化支气管扩张症可能由于黏液纤毛清除功能受损和慢性黏液潴留而促进真菌定植。基于临床原理和现有文献，采用了包括全身伏立康唑和吸入两性霉素B（尽管尚未标准化）的联合抗真菌治疗，取得了良好效果。肺部感染在患有支气管扩张症的免疫功能正常宿主中虽然罕见，但在出现新的或持续的浸润影时应予以考虑。早期识别和个体化抗真菌策略，包括吸入药物的潜在作用，可能会改善临床结果。该病例强化了多学科协作在慢性气道疾病复杂真菌感染管理中的重要性。
