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Open Access Highly Accessed Case report

Fatal pneumonia caused by Penicillium digitatum: a case report

Chiyako Oshikata1, Naomi Tsurikisawa1*, Akemi Saito1, Maiko Watanabe2, Yoichi Kamata2, Maki Tanaka3, Takahiro Tsuburai1, Hiroyuki Mitomi1, Kosuke Takatori3, Hiroshi Yasueda1 and Kazuo Akiyama1

Author Affiliations

1 Clinical Research Centre for Allergy and Rheumatology, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan

2 Division of Microbiology, National Institute of Health Science, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo, 158–8501, Japan

3 Centre for Fungal Consultation, 5F 4-8-5, Chuo, Tsurumi-ku, Yokohama, Kanagawa, 230-0051, Japan

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BMC Pulmonary Medicine 2013, 13:16  doi:10.1186/1471-2466-13-16

Published: 23 March 2013

Abstract

Background

Penicillium species are among the most common fungi present in the environment and are usually considered non-pathogenic to humans. However, in immunocompromised hosts they can be virulent pathogens and can cause death. Penicillium digitatum is a plant pathogen that commonly causes a postharvest fungal disease of citrus called green mould; it very rarely causes systemic mycosis in humans. Here, we report a case of fatal pneumonia due to P. digitatum infection, as confirmed by repeated examination of cultured sputum.

Case presentation

A cavity was found in the left upper lung on routine chest X-ray in a 78-year-old undernourished male who had been diagnosed at age 66 with bronchial asthma and pulmonary emphysema. No increased sputum production was present. The presence of antigen-specific precipitating antibodies to Aspergillus flavus and P. digitatum was confirmed in the patient’s serum and also later pleural fluid by using Ouchterlony double immunodiffusion testing with A. flavus and P. digitatum antigens. The patient was treated over a period of months with itraconazole, micafungin, voriconazole, amphotericin B, and antibacterials. However, the cavity enlarged, the pleural effusion increased, and the patient began producing purulent sputum. He died from progressive renal failure. From sputum culture only one fungus was isolated repeatedly on potato-dextrose agar in large quantities. This fungus was confirmed to be P. digitatum by molecular identification. Partial sequences of the beta-tubulin gene were determined by using the primers Bt2a and Bt2b for PCR amplification and sequencing and underwent a BLAST search at the National Centre for Biotechnology Information, these results confirmed that the isolated fungus was P. digitatum.

Conclusion

To our knowledge, this is the first report of pulmonary infection with P. digitatum. Our patient had pulmonary emphysema and was elderly, and undernourished. These factors might have facilitated the infection. In his case, antimycotics were ineffective in treating the lung involvement. Although human infection with P. digitatum is considered rare, it appears that this organism can be very virulent and resistant to antimycotics.

Keywords:
Penicillium digitatum; Penicillium species; Infection; Immunocompromised host; Pulmonary emphysema; Pneumonia