Clinical Citations: An unusual fungus causes lung granulomata and mimics Crohn disease

Scott and associates described a case of Phialemonium obovatum fungemia in a bone marrow transplant recipient. This fungal infection was associated with caseating granulomata in the lungs and GI involvement that resembled Crohn disease.

The patient had chronic myelogenous leukemia. Six months after undergoing peripheral bone marrow transplantation, graft versus host disease developed, characterized by skin and liver involvement, fever, and severe diarrhea. The results of fecal bacterial cultures and serologic tests for Cytomegalovirus were negative.

CT scanning detected a peripheral pulmonary mass. Biopsy of the lung lesion revealed septate branching hyphae with terminal globular structures. The hyphae were similar in appearance to those of Aspergillus species, except they were more moniliform. Blood cultures confirmed the presence of P obovatum infection.

The patient received amphotericin B and itraconazole for 6 months, but his diarrhea persisted. Biopsy specimens from the stomach, colon, and rectum revealed granulomatous inflammation and a marked crypt distortion that mimicked Crohn disease.

The authors note that susceptibility testing indicated that this organism was resistant to both amphotericin B and itraconazole, but was susceptible to voriconazole and posaconazole.