A Suspected Case of Allergic Bronchopulmonary Mycosis Associated With Exophiala dermatitidis.

Abstract

Exophiala dermatitidis is a black fungus that can colonize the airways, but allergic bronchopulmonary mycosis (ABPM) associated with E. dermatitidis is rare. An 83-year-old former smoker without asthma presented with exertional dyspnea. Chest CT showed bronchiectasis and a mucus plug in the left B³ bronchus. One month after discharge for acute cholecystitis, he returned with cough. Chest CT showed enlargement of the mucus plug and an infiltrative shadow in the left upper lobe. Despite piperacillin/tazobactam therapy for suspected bacterial pneumonia, cough and radiological findings persisted. Laboratory findings showed eosinophilia of 546/μL and total IgE of 823 IU/mL. Bronchoscopy on hospital day 4 revealed the mucus plug, and cultures yielded E. dermatitidis. ABPM associated with E. dermatitidis was suspected. Corticosteroid and voriconazole therapy improved cough, radiological findings and eosinophilia. This case suggests E. dermatitidis may be involved in ABPM, even without cystic fibrosis.