1.A rare case of Coniochaetta hoffmannii fungus ball in an immunocompetent host.
Journal of the Philippine Medical Association 2021;100(1):66-76
INTRODUCTION:
Fungal balls are commonly associated
with the Aspergillus species. The hyaline hyphae is
not diagnostic of a fungus ball's causative
organism hence the need for fungal culture.
Systemic fungal infections are rarely seen in
immunocompetent persons.
CASE:
A 45-year-old male presented with a nine
month history of nonproductive cough progressing
to hemoptysis. His chest tomography with contrast
revealed a mass measuring 6.5cm x 5.5cm x 6.9cm
located in the left upper lobe, with a smooth lining
and air crescent sign consistent with aspergilloma.
Serum galactomannan assay was positive. Patient
was treated medically for Aspergillus sp infection
with voriconazole and itraconazole for six months
with no response. A left upper lobectomy was
done. Lung tissue biopsy and histopathologic
examination showed hyphal elements with
branching short lateral necks. Culture studies
revealed a rare microorganism namely
Coniochaetta hoffmannii. Post-operatively, our
patient improved and was eventually discharged.
DISCUSSION:
Coniochaetta hoffmannii is a rare
human pathogen and is only implicated in
those immunocompromised. Thorough clinical
investigation led to the identification of this
organism. Literature review reveals scant
inconclusive treatment approaches. Surgical
intervention proved therapeutic for our patient.
CONCLUSION
Not all fungal balls are caused by
Aspergillus sp. Culture studies remains the gold
standard in identifying specific organism causing
fungus balls. Rare micro-organisms such as Coniochaeta hoffmanii. can be isolated. Invasive
fungal infection can occur in an immunocompetent
host. The outcome of this study will contribute to
the limited pool of information on the diagnosis and
management of similar cases.