Case of pulmonary sporotrichosis.
This article describes the case of a 44-year-old African American male patient with diagnosed with pulmonary sporotrichosis after chemotherapy. The patient had a history of pulmonary sporotrichosis and was treated with itraconazole in 2008 and in 2011 for 5 months. The treatment was discontinued when the patient sputum culture was negative. The patient’s history revealed that he was a transporter for bird seed bags and had a history of smoking 10 pack/year and 3 cans of beer per week.
The patient did not show any symptoms from May 2021 to July 2015. He presented to the hospital with symptoms of dysphagia and hemoptysis. Doctors advised a chest CT which showed a retropharyngeal mass in the right upper lobe cavity and left upper lobe, measuring 35 × 12 × 8 mm. Multiple small nodules were also seen with low FDG uptake on PET scan.
The neck abscess was incised and drained, the cultures grew streptococcus viridians and Candida. Doctors advised an esophageal biopsy which was positive for squamous cell carcinoma. Bronchoscopy and bronchoalveolar lavage (BAL) of the left upper lobe showed a predominance of neutrophils. BAL was positive for alpha hemolytic streptococci.
Treatment included broad-spectrum antibiotic therapy.
Doctors treated the patient with fluconazole, levofloxacin, metronidazole and vancomycin for 3 weeks. After consultation with oncology, the patient was started on chemotherapy and paclitaxel along with radiation therapy. The treatment started on August 2015 and completed in September 2015. Follow-up PET and CT scan showed marked improvement of the esophageal mass and extensive cavitary pulmonary lesions bilaterally. However, an increase was noted in the size, number and FDG metabolic activities of the bilateral pulmonary nodules.
BAL of the right and lower lobes showed Sporothrix schenckii sensu lato for which the patient was started on itraconazole, twice daily. Repeat CT scan of the chest showed worsening destructive cavitary changes that involved the left lung. Whereas right-sided pulmonary nodules increased in size and some started to cavitate. Microbiology confirmed the presence of Sporothrix schenckii sensu lato. Pathology showed numerous granulomas and caseating necrosis which led to the diagnosis of sporotrichosis relapse.
Repeat CT taken a year later showed resolution of the cavitary lesions and an improvement in the right lower lobe nodules.
References
The Infection Returns: A Case of Pulmonary Sporotrichosis Relapse after Chemotherapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835281/
