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Case Report
showed diminished infiltrative shadow and all repeated creases the risk of pulmonary mycosis. Ubiquitous in na-
culture tests were negative. He was, then, discharged and ture and without geographic predilection, mold is found in
required to take itraconazole(Sporanox,Xian Janssen Phar- soil, manure, sewage, polluted water and decaying vegeta-
maceutical Ltd,Xian,China) orally for two weeks. tion. Drowning victims may aspirate contaminated water
that contains a higher concentration of mold, leading to
Discussion large inoculums[8]. Without effective host defenses follow-
ing pulmonary exposure, the conidia resting in the alveoli
Pulmonary mycosis, a severe fungal infection of the begins to enlarge and germinate. Hyphal transformation
lung, is among the most feared and challenging infec- with vascular invasion and dissemination of infection can
tions. It usually occurs in primary or secondary immuno- then potentially take place[9]. Moreover, the injury sus-
suppressed individuals, such as those suffering from major tained by the lungs in the immersion event may have ren-
burns, AIDS, immune disorders or transplant recipients [6]. dered them more susceptible to microbial proliferation and
However, it is very rare in immuno-competent hosts but invasion .[10] The significant damage done to the epithelial
has been described in previously healthy individuals after lining of the lungs places these individuals at higher risk for
submersion and neardrowning. Scedosporium apiosper- developing pulmonary infection .Furthermore, monitoring
mum, a soil and waterborne fungus, has been incriminated in the intensive care unit, mechanical ventilation, together
as a common causative agent after near-drowning. It can with the therapy of corticosteroids and antibiotics may
cause a variety of clinical manifestations and affects both have rendered our patient more vulnerable to mycosis .[11]
immuno-competent and immuno-compromised patients. The two patients in our report were admitted to the ICU,
In our case report, both patients were healthy young man, and treated with a protocol of antibiotics and steroids,
who did not have any underlying disease that may de- both of which are predisposed to fungal infection.
crease the immune response.
Making the diagnosis of pulmonary mycosis plays a
A submersion event in contaminated water likely in- major role in the final outcome of the patient. The defi-
nite diagnosis relies on etiological identification by fungal
culture and histopathological evidence [7]. Such diagnostic
methods require an invasive procedure which some pa-
Figure 1 In case 1, CT scan of the chest on admission reveal- Figure 3 In case 1, about 2 weeks after admission,MRI brain
ing the presence of cavities and nodules in both lungs. scan revealed multiple lesions that were enhanced after IV
gadolinium.
Figure 2 In case 1, after the treatment, CT scan of the chest Figure 4 In case 1, after the treatment, MRI brain scan show-
showing clearance of the nodular opacities. ing the disappearance of the multiple lesions.
Laboratory and Clinical CInavseestRigeaptoiortn 463 FAM 2014 Nov/Dec Vol.21 Issue 6
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