Respiratory Failure Caused by Adiaspiromycosis: Case Reports (Part 4)

Repeated examinations and cultures of sputum revealed no acid-fast bacilli or fungi. Tuberculin, histoplasmin, coccidioidin, paracoccidioidin, sporotrichin and haplosporangin skin tests were negative. The DNCB skin test was positive. A transbronchial biopsy was performed, showing a granulomatous process with an unidentified organism in the center of the granulomas. An open chest biopsy was then performed, aimed at a better characterization of the organism. The new histopathologic material was also initially interpreted as a case of helminthic infestation, but the diagnosis of adiaspiromycosis was subsequently confirmed. Forty-eight hours after open lung biopsy, the fever ceased and the patient felt better without any specific therapy. A therapeutic trial with amphotericin B was interrupted because of adverse reactions. Inhalations with pimaricin, 2.5 mg tid, were started and maintained for 45 days. A few weeks later, the factory was inspected. There were no traces of rodents in the locality and cultures of the collected dust were negative for Emmonsia crescens. The patients condition progressively improved. Six months later, he became asymptomatic with normal thorax x-ray film and pulmonary function tests.
Histopathologic Findings
The histologic changes were similar in the three performed biopsies—an open lung biopsy of the first patient and an open lung as well as a transbronchial biopsy performed in the second patient.

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