Infection and Drug Resistance (Aug 2022)
Bronchial Artery-Pulmonary Artery Shunt by Apiotrichum mycotoxinivorans Infection in a Recurrent Hemoptysis Case
Abstract
Yu Pang,1 Diefei Hu,1 Yiwu Dang,2 Siming Huang,3 Lanhui Qin,4 Meng Li5 1Department of Infectious Disease, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 2Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 3Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 4Department of Radiology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China; 5Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of ChinaCorrespondence: Meng Li, Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People’s Republic of China, Tel/Fax +8613367809642, Email [email protected]: Apiotrichum mycotoxinivorans is a rare mycotoxinivorans, and its pathogenicity is unknown. Bronchial artery shunt is a pathophysiological state following congenital or acquired chronic infection. We report a rare case of bronchial artery shunt by A. mycotoxinivorans infection in a recurrent hemoptysis patient.Case Presentation: A 45-year-old female presented with recurrent cough and hemoptysis for 4 years. Before admission, she had been treated in several hospitals for pulmonary tuberculosis and bronchiectasis and received standardized anti-tuberculosis treatment for 1 year, but it was ineffective. After admission, CTPA and bronchial arterial angiography showed left bronchial artery–left pulmonary artery shunt and right bronchial artery–right pulmonary artery shunt. Fiber-optic bronchoscopy was performed, which revealed a large amount of purulent secretions, bronchoalveolar lavage fluid fungi (1-3)-β-d glucan: 728.06, and GM test: 3.239. Fungal hyphae and spores were observed by gram staining of BALF smear. Acid-fast bacilli were not found in BALF smear and brush smear. Two consecutive BALF fungal cultures grew A. mycotoxinivorans, the identity of which was confirmed by internal-transcribed-spacer (ITS) sequencing. Intravenous amphotericin B liposome (30mg; 0.5mg/kg, QD) was given for 2 weeks, embolization was performed, and itraconazole (voriconazole allergy) was taken orally for 9 months after operation. Hemoptysis and pulmonary lesions gradually improved after treatment.Conclusion: We report the first case of bronchial artery–pulmonary artery shunt in a patient diagnosed with A. mycotoxinivorans infection. Phagocytosis of fungi by leukocytes was observed, and the pathogenicity of the fungus was confirmed in order to heighten the awareness of these infections.Keywords: Apiotrichum mycotoxinivorans, bronchial artery–pulmonary artery shunt, hemoptysis, infection
