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Open Access Highly Accessed Case report

Pulmonary fungus ball caused by Penicillium capsulatum in a patient with type 2 diabetes: a case report

Min Chen1, Jos Houbraken2, Weihua Pan1, Chao Zhang1, Hao Peng3, Lihui Wu3, Deqiang Xu4, Yiping Xiao4, Zhilong Wang3 and Wanqing Liao1*

Author Affiliations

1 Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Shanghai Changzheng Hospital, Shanghai, China

2 Department of Applied and Industrial Mycology, CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands

3 Department of Thoracic Surgery, Shanghai Changzheng Hospital, Shanghai, China

4 The College of Life Science, Fudan University, Shanghai, China

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BMC Infectious Diseases 2013, 13:496  doi:10.1186/1471-2334-13-496

Published: 23 October 2013

Abstract

Background

Following the recent transfer of all accepted species of Penicillium subgenus Biverticillium to Talaromyces (including Talaromyces marneffei, formerly Penicillium marneffei), Penicillium species are becoming increasingly rare causal agents of invasive infections. Herein, we present a report of a type 2 diabetes patient with a fungus ball in the respiratory tract caused by Penicillium capsulatum.

Case presentation

A 56-year-old Chinese female gardener with a 5-year history of type 2 diabetes presented at the Shanghai Changzheng Hospital with fever, a cough producing yellow-white sputum, and fatigue. The therapeutic effect of cefoxitin was poor. An HIV test was negative, but the β-D-glucan test was positive (459.3 pg/ml). Chest radiography revealed a cavitary lesion in the left upper lobe, and a CT scan showed globate cavities with a radiopaque, gravity-dependent ball. The histopathologic features of the tissue after haematoxylin-eosin staining showed septate hyphae. The fungus was isolated from the gravity-dependent ball and identified as Penicillium capsulatum based on the morphological analysis of microscopic and macroscopic features and on ribosomal internal transcribed spacer sequencing. After surgery, the patient was cured with a sequential treatment of fluconazole 400 mg per day for 90 days and caspofungin 70 mg per day for 14 days.

Conclusions

Although the prognosis is often satisfactory, clinicians, mycologists and epidemiologists should be aware of the possibility of infection by this uncommon fungal pathogen in diabetes patients, since it may cause severe invasive infections in immunocompromised hosts such as diabetes and AIDS patients.

Keywords:
Fungal ball; Pulmonary infections; Penicillium capsulatum