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  • Unusual manifestation of pulmonary Verruconis gallopava infection with synchronous reactive pericardial effusion in a non-transplanted patient

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Case Reports: Rare disease
Unusual manifestation of pulmonary Verruconis gallopava infection with synchronous reactive pericardial effusion in a non-transplanted patient
  1. Napat Jirawat and
  2. Nophol Leelayuwatanakul
  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  1. Correspondence to Nophol Leelayuwatanakul; L.nophol{at}gmail.com

Abstract

Verruconis gallopava is an emerging causative agent in solid organ transplant patients, increasing in prevalence both in non-transplanted patients and also in immunocompetent ones, albeit rarely. In this case report, we describe an unusual V. gallopava infection in a patient with steroid-dependent autoimmune haemolytic anaemia. The chest CT scan revealed a mass-like consolidation in the superior segment of the right lower lobe, and bronchoscopic examination confirmed V. gallopava from bronchoalveolar lavage. The histopathology showed non-necrotising granulomatous inflammation concurrent with septate-pigmented hyphae, which is compatible with dematiaceous fungi. After 3 weeks of posaconazole treatment, the patient developed a new pericardial effusion. Further investigations, including culture, cytology and histopathology, yielded negative results, leading to suspicion of reactive pericardial effusion associated with V. gallopava pulmonary infection. The patient received antifungal therapy for 9 months, after which a follow-up chest CT scan showed complete resolution of consolidation and pericardial effusion.

  • Respiratory medicine
  • Pneumonia (respiratory medicine)

http://dx.doi.org/10.1136/bcr-2022-251835

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: NJ and NL. The following authors gave final approval of the manuscript: NL. Is the patient one of the authors of this manuscript?: no. NJ plays a vital role in the data collection, data interpretation, conception and design of the original draft of this case report and in critically revising the manuscript for intellectual information. NL contributed to the revision and final approval of this paper. All authors agree to be accountable for the accuracy of the work and to read and approve the final manuscript before submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.