A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection?
<b>Background:</b> <i>Exophiala dermatitidis</i> is a dematiaceous, thermotolerant, yeast-like fungus increasingly recognized as an opportunistic pathogen in chronic airway diseases. While commonly associated with cystic fibrosis, its clinical significance in non-cystic fibro...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-06-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/15/13/1661 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849428655513534464 |
|---|---|
| author | Francesco Rocco Bertuccio Nicola Baio Simone Montini Valentina Ferroni Vittorio Chino Lucrezia Pisanu Marianna Russo Ilaria Giana Elisabetta Gallo Lorenzo Arlando Klodjana Mucaj Mitela Tafa Maria Arminio Emanuela De Stefano Alessandro Cascina Angelo Guido Corsico Giulia Maria Stella Valentina Conio |
| author_facet | Francesco Rocco Bertuccio Nicola Baio Simone Montini Valentina Ferroni Vittorio Chino Lucrezia Pisanu Marianna Russo Ilaria Giana Elisabetta Gallo Lorenzo Arlando Klodjana Mucaj Mitela Tafa Maria Arminio Emanuela De Stefano Alessandro Cascina Angelo Guido Corsico Giulia Maria Stella Valentina Conio |
| author_sort | Francesco Rocco Bertuccio |
| collection | DOAJ |
| description | <b>Background:</b> <i>Exophiala dermatitidis</i> is a dematiaceous, thermotolerant, yeast-like fungus increasingly recognized as an opportunistic pathogen in chronic airway diseases. While commonly associated with cystic fibrosis, its clinical significance in non-cystic fibrosis bronchiectasis (NCFB) remains unclear. <b>Case Presentation:</b> We report the case of a 66-year-old immunocompetent woman with a history of breast cancer in remission and NCFB, who presented with chronic cough and dyspnea. Chest CT revealed bilateral bronchiectasis with new pseudonodular opacities. Bronchoalveolar lavage cultures identified <i>E. dermatitidis</i>, along with <i>Pseudomonas aeruginosa</i> and methicillin-sensitive <i>Staphylococcus aureus</i>. Given clinical stability and the absence of systemic signs, initial therapy included oral voriconazole, levofloxacin, doxycycline, and inhaled amikacin. Despite persistent fungal isolation on repeat bronchoscopy, the patient remained asymptomatic with stable radiologic and functional findings. Antifungal therapy was discontinued, and the patient continued under close monitoring. The patient exhibited clinical and radiological stability despite repeated fungal isolation, reinforcing the hypothesis of persistent colonization rather than active infection. <b>Discussion:</b> This case underscores the diagnostic challenges in distinguishing fungal colonization from true infection in structurally abnormal lungs. In NCFB, disrupted mucociliary clearance and microbial dysbiosis may facilitate fungal persistence, even in the absence of overt immunosuppression. The detection of <i>E. dermatitidis</i> should prompt a comprehensive evaluation, integrating clinical, radiologic, and microbiologic data to guide management. Voriconazole is currently the antifungal agent of choice, though therapeutic thresholds and duration remain undefined. <b>Conclusions:</b> This report highlights the potential role of <i>E. dermatitidis</i> as an under-recognized respiratory pathogen in NCFB and the importance of a multidisciplinary, individualized approach to diagnosis and treatment. This case underscores the need for further research on fungal colonization in NCFB and the development of evidence-based treatment guidelines. Further studies are needed to clarify the pathogenic significance, optimal management, and long-term outcomes of <i>E. dermatitidis</i> in non-CF chronic lung diseases. |
| format | Article |
| id | doaj-art-c2637f7588bc47feaf1c9e7775c6cff2 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-c2637f7588bc47feaf1c9e7775c6cff22025-08-20T03:28:37ZengMDPI AGDiagnostics2075-44182025-06-011513166110.3390/diagnostics15131661A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection?Francesco Rocco Bertuccio0Nicola Baio1Simone Montini2Valentina Ferroni3Vittorio Chino4Lucrezia Pisanu5Marianna Russo6Ilaria Giana7Elisabetta Gallo8Lorenzo Arlando9Klodjana Mucaj10Mitela Tafa11Maria Arminio12Emanuela De Stefano13Alessandro Cascina14Angelo Guido Corsico15Giulia Maria Stella16Valentina Conio17Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyOspedale Maggiore, ASST Crema, 26013 Crema, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyOspedale Pederzoli, Peschiera del Garda, 37121 Verona, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, ItalyUnit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy<b>Background:</b> <i>Exophiala dermatitidis</i> is a dematiaceous, thermotolerant, yeast-like fungus increasingly recognized as an opportunistic pathogen in chronic airway diseases. While commonly associated with cystic fibrosis, its clinical significance in non-cystic fibrosis bronchiectasis (NCFB) remains unclear. <b>Case Presentation:</b> We report the case of a 66-year-old immunocompetent woman with a history of breast cancer in remission and NCFB, who presented with chronic cough and dyspnea. Chest CT revealed bilateral bronchiectasis with new pseudonodular opacities. Bronchoalveolar lavage cultures identified <i>E. dermatitidis</i>, along with <i>Pseudomonas aeruginosa</i> and methicillin-sensitive <i>Staphylococcus aureus</i>. Given clinical stability and the absence of systemic signs, initial therapy included oral voriconazole, levofloxacin, doxycycline, and inhaled amikacin. Despite persistent fungal isolation on repeat bronchoscopy, the patient remained asymptomatic with stable radiologic and functional findings. Antifungal therapy was discontinued, and the patient continued under close monitoring. The patient exhibited clinical and radiological stability despite repeated fungal isolation, reinforcing the hypothesis of persistent colonization rather than active infection. <b>Discussion:</b> This case underscores the diagnostic challenges in distinguishing fungal colonization from true infection in structurally abnormal lungs. In NCFB, disrupted mucociliary clearance and microbial dysbiosis may facilitate fungal persistence, even in the absence of overt immunosuppression. The detection of <i>E. dermatitidis</i> should prompt a comprehensive evaluation, integrating clinical, radiologic, and microbiologic data to guide management. Voriconazole is currently the antifungal agent of choice, though therapeutic thresholds and duration remain undefined. <b>Conclusions:</b> This report highlights the potential role of <i>E. dermatitidis</i> as an under-recognized respiratory pathogen in NCFB and the importance of a multidisciplinary, individualized approach to diagnosis and treatment. This case underscores the need for further research on fungal colonization in NCFB and the development of evidence-based treatment guidelines. Further studies are needed to clarify the pathogenic significance, optimal management, and long-term outcomes of <i>E. dermatitidis</i> in non-CF chronic lung diseases.https://www.mdpi.com/2075-4418/15/13/1661<i>Exophiala dermatitidis</i>fungal lung infectiondematiaceous fungicolonizationnon-cystic bronchiectasischronic airway disease |
| spellingShingle | Francesco Rocco Bertuccio Nicola Baio Simone Montini Valentina Ferroni Vittorio Chino Lucrezia Pisanu Marianna Russo Ilaria Giana Elisabetta Gallo Lorenzo Arlando Klodjana Mucaj Mitela Tafa Maria Arminio Emanuela De Stefano Alessandro Cascina Angelo Guido Corsico Giulia Maria Stella Valentina Conio A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection? Diagnostics <i>Exophiala dermatitidis</i> fungal lung infection dematiaceous fungi colonization non-cystic bronchiectasis chronic airway disease |
| title | A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection? |
| title_full | A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection? |
| title_fullStr | A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection? |
| title_full_unstemmed | A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection? |
| title_short | A Rare Case of Exophiala Dermatitidis Isolation in a Patient with Non-Cystic Fibrosis Bronchiectasis: Colonization or True Infection? |
| title_sort | rare case of exophiala dermatitidis isolation in a patient with non cystic fibrosis bronchiectasis colonization or true infection |
| topic | <i>Exophiala dermatitidis</i> fungal lung infection dematiaceous fungi colonization non-cystic bronchiectasis chronic airway disease |
| url | https://www.mdpi.com/2075-4418/15/13/1661 |
| work_keys_str_mv | AT francescoroccobertuccio ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT nicolabaio ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT simonemontini ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT valentinaferroni ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT vittoriochino ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT lucreziapisanu ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT mariannarusso ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT ilariagiana ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT elisabettagallo ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT lorenzoarlando ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT klodjanamucaj ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT mitelatafa ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT mariaarminio ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT emanueladestefano ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT alessandrocascina ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT angeloguidocorsico ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT giuliamariastella ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT valentinaconio ararecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT francescoroccobertuccio rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT nicolabaio rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT simonemontini rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT valentinaferroni rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT vittoriochino rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT lucreziapisanu rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT mariannarusso rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT ilariagiana rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT elisabettagallo rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT lorenzoarlando rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT klodjanamucaj rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT mitelatafa rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT mariaarminio rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT emanueladestefano rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT alessandrocascina rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT angeloguidocorsico rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT giuliamariastella rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection AT valentinaconio rarecaseofexophialadermatitidisisolationinapatientwithnoncysticfibrosisbronchiectasiscolonizationortrueinfection |