CHEST Guidelines-A-66-Year-Old-Woman-With-Progressive-Dyspnea-and-O

A-66-Year-Old-Woman-With-Progressive-Dyspnea-and-O

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A 66-year-old woman with a history of diabetes presented with progressive dyspnea, low-grade fever, cough, and decreased activity over three months. Initially, she was diagnosed with mucormycosis and treated with amphotericin B, but her condition worsened. A case report from Peking University First Hospital revealed the accurate diagnosis of an invasive pulmonary infection due to the fungus Trichoderma longibrachiatum. Trichoderma species are saprophytic, filamentous fungi found globally in soil and decaying vegetation and can cause invasive infections, particularly in immunocompromised individuals. These infections can show signs such as nodules, pleural effusion, and consolidations on CT imaging, often mimicking aspergillosis. <br /><br />In this case, the diagnosis was confirmed through imaging showing bronchial occlusion, observing fungal hyphae in pleural effusion, and negative results for other fungal antibodies. Trichoderma longibrachiatum was identified through metagenomic sequencing. The initial treatment for mucormycosis, amphotericin B, was ineffective due to its poor tissue penetration and the fungus's potential resistance. The patient responded positively to voriconazole, with symptoms improving and chest CT scans showing marked recovery post-treatment.<br /><br />Trichoderma infections can be challenging to treat due to their high resistance to antifungal agents and resemble other fungal infections. Therapeutic strategies can include antifungal medications such as voriconazole or surgical excision based on the infection's severity. The case underlines the importance of accurate diagnosis and appropriate antifungal therapy, as untreated or mismanaged Trichoderma infections carry a high mortality rate. The paper emphasizes the necessity of distinguishing Trichoderma infections from similar fungal infections to ensure effective treatment.

Keywords

Trichoderma longibrachiatum

invasive pulmonary infection

immunocompromised

voriconazole

antifungal resistance

metagenomic sequencing

bronchial occlusion

pleural effusion

mucormycosis

accurate diagnosis