Challenging diagnosis of pulmonary scedosporiosis in an immunocompetent elderly woman

ABSTRACT

We report a rare case of pulmonary Scedosporium infection in a 64-year-old immunocompetent woman who presented with exertional dyspnea and intermittent wheezing. Imaging revealed a right lower lobe infiltrate, with a positron emission tomography (PET) scan showing hypermetabolic activity, raising concern for malignancy. CT-guided biopsy showed noncaseating granulomas that suggested a broad list of differential diagnosis. Eventually, bronchoalveolar lavage cultures identified Scedosporium species. The patient was managed with antifungal therapy. This case highlights the diagnostic challenges of fungal infections in immunocompetent individuals and the importance of considering opportunistic pathogens even in the absence of classical risk factors.

Keywords: Pulmonary scedosporium infection, immunocompetent host, noncaseating granulomatous lung disease