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• W4387249181 abstract "SESSION TITLE: Unusual Chest Infections 2 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Allergic Bronchopulmonary Mycosis (ABPM) is a hypersensitivity-mediated disease in response to the presence of fungi in the airways, most commonly Aspergillus (ABPA). It is characterized by poorly controlled asthma, peripheral eosinophilia, elevated fungi specific IgE, and bronchopulmonary manifestations seen on high-resolution computed tomography (HRCT) with central bronchiectasis, fixed or transient pulmonary opacities, and high attenuation mucus. ABPM cases due to non-Aspergillus fungi have been increasing. Basidiomycetes have been reported as an emerging pathogen responsible for allergic and invasive lung diseases. Irpex is a Basidiomycete found on decaying wood. Lung disease due to Irpex species is very rare. Upon extensive review of the published literature, we found two cases of Irepex species causing lung disease none of which were ABPM. CASE PRESENTATION: A 68-year-old immunocompetent male with a five-year history of poorly controlled and progressive asthma-like symptoms including cough with copious amount of phlegm, dyspnea, and wheezing. He worked as a carpenter and reported significant exposure to decaying wood dust with poor compliance to personal protective equipment. The patient required multiple hospitalizations for severe asthma exacerbation associated with marked peripheral eosinophilia (1.29 K/μL). Pulmonary function testing was consistent with moderate airflow obstruction and normal lung volumes. HRCT scan demonstrated multi-lobar parenchymal opacities. The patient underwent bronchoscopy which revealed no mucous plugs, bronchoalveolar lavage grew Irpex species on fungal cultures. DISCUSSION: The incidence of pulmonary infections with environmental fungi are increasing. This is thought to be due to multiple risk factors including the wide use of medical instrumentation, use of immunosuppressive and immunomodulatory agents, and the agricultural use of -azole antifungals. It's estimated that 2.5% of adults with asthma to suffer from ABPA, however ABPM due to other fungi species is rare. In 2013, a global review study of ABPM due to fungi other than Aspergillus revealed 143 reported global cases, none of which were due to Irpex species, and one third of these cases were from USA, Australia, and Europe.Non-Aspergillus ABPM is currently underdiagnosed, and its diagnosis is more challenging. In one review study, bronchial asthma was present in only 32% of non-Aspergillus ABPM cases. Furthermore, the median IgE level was found threefold higher than that of ABPA which may suggest that non-Aspergillus ABPM could provoke a stronger immunological response. In another study, the clinical course of non-Aspergillus ABPM is often atypical.There are no current treatment guidelines for infections due to Irpex species. In one case report of an immunocompromised child with lung abscess due to Irpex Lacteus, there was poor clinical response to systemic Voriconazole. Subsequently, the patient was switched to Amphotericin B with improvement in fever and pulmonary nodules. CONCLUSIONS: Non-Aspergillus ABPM is a rare entity with small number of cases reported in the literature. The clinical diagnosis should be suspected in patients with risk factors presenting with asthma-like symptoms associated with abnormal chest imaging, peripheral eosinophilia, and elevated IgE. Further studies needed to determine its prevalence and definitive diagnostic criteria and therapy. To our knowledge, this is the first case report of non-Aspergillus ABPM caused by Irepex species. REFERENCE #1: Asano K, Hebisawa A, Ishiguro T, Takayanagi N, Nakamura Y, Suzuki J, Okada N, Tanaka J, Fukutomi Y, Ueki S, Fukunaga K, Konno S, Matsuse H, Kamei K, Taniguchi M, Shimoda T, Oguma T; Japan ABPM Research Program. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. J Allergy Clin Immunol. 2021 Apr;147(4):1261-1268.e5. doi: 10.1016/j.jaci.2020.08.029. Epub 2020 Sep 10. PMID: 32920094. REFERENCE #2: Chowdhary A, Agarwal K, Kathuria S, Gaur SN, Randhawa HS, Meis JF. Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview. Crit Rev Microbiol. 2014 Feb;40(1):30-48. doi: 10.3109/1040841X.2012.754401. Epub 2013 Feb 5. PMID: 23383677. REFERENCE #3: Buzina W, Lass-Flörl C, Kropshofer G, Freund MC, Marth E. The polypore mushroom Irpex lacteus, a new causative agent of fungal infections. J Clin Microbiol. 2005 Apr;43(4):2009-11. doi: 10.1128/JCM.43.4.2009-2011.2005. PMID: 15815046; PMCID: PMC1081321. DISCLOSURES: No relevant relationships by Rene Franco No relevant relationships by Mohamed Mansour No relevant relationships by Husam Nayef" @default.
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• W4387249181 date "2023-10-01" @default.
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• W4387249181 title "A RARE CASE OF ALLERGIC BRONCHOPULMONARY MYCOSIS CAUSED BY IRPEX SPECIES" @default.
• W4387249181 doi "https://doi.org/10.1016/j.chest.2023.07.692" @default.
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