Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2024; 12(10): 1772-1777
Published online Apr 6, 2024. doi: 10.12998/wjcc.v12.i10.1772
Successful treatment of Purpureocillium lilacinum pulmonary infection with isavuconazole: A case report
Xue-Lin Yang, Jun-Yu Zhang, Jian-Min Ren
Xue-Lin Yang, Department of Emergency Medicine, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Jun-Yu Zhang, Department of Hematology, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Jian-Min Ren, Department of Clinical Laboratory, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
Author contributions: Zhang JY conceived and designed the experiments, was responsible for the revision of the manuscript for important content; Yang XL collected information of case and drafted the manuscript; Ren JM performed the microbiological analyses. All authors critically reviewed and approved the final manuscript.
Informed consent statement: The patient has given us written informed consent for publication as a case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Yu Zhang, MD, MM, Associate Chief Physician, Chief Doctor, Department of Hematology, Lishui Central Hospital, No. 289 Kuocang Road, Lishui 323000, Zhejiang Province, China. zhangjunyu815@163.com
Received: October 16, 2023
Peer-review started: October 16, 2023
First decision: January 24, 2024
Revised: February 5, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 6, 2024
Abstract
BACKGROUND

Purpureocillium lilacinum (P. lilacinum) is a saprophytic fungus widespread in soil and vegetation. As a causative agent, it is very rarely detected in humans, most commonly in the skin.

CASE SUMMARY

In this article, we reported the case of a 72-year-old patient with chronic lymphocytic leukemia who was admitted with cough and fever. Computed tomography revealed an infection in the right lower lobe. Bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing were ultimately confirmed to have a pulmonary infection with P. lilacinum. She was eventually discharged with good outcomes after treatment with isavuconazole.

CONCLUSION

Pulmonary infection with P. lilacinum was exceedingly rare. While currently there are no definitive therapeutic agents, there are reports of high resistance to amphotericin B and fluconazole and good sensitivity to second-generation triazoles. The present report is the first known use of isavuconazole for pulmonary P. lilacinum infection. It provides new evidence for the characterization and treatment of clinical P. lilacinum lung infections.

Keywords: Purpureocillium lilacinum, Pulmonary infection, Isavuconazole, Case report

Core Tip: Pulmonary infection caused by Purpureocillium lilacinum (P. lilacinum) is exceedingly rare, with uncharacteristic clinical symptoms, signs, and imaging findings. In this case, we reported an older woman with chronic lymphocytic leukemia, long-standing ibrutinib, poor immune function, and fever and cough was admitted to a hematologic department. The patient was diagnosed with P. lilacinum pulmonary infection based on bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing. Conventional antifungal agents often have inherent resistance. Isavuconazole was found to have good safety and efficacy. This is the first known use of isavuconazole for pulmonary P. lilacinum infection. After treatment with isavuconazole, the clinical symptoms of cough and fever improved, and the patient was discharged from the hospital.