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Patient-derived AR<jats:italic>Af<\/jats:italic> occurs after prolonged azole treatment in patients with aspergillosis and involves various <jats:italic>cyp51A<\/jats:italic> point mutations or non<jats:italic>-cyp51A<\/jats:italic> mutations. The prognosis of patients with chronic pulmonary aspergillosis (CPA) with patient-derived AR<jats:italic>Af<\/jats:italic> infection remains unclear. In this study, we reported the case of a patient with AR<jats:italic>Af<\/jats:italic> due to HapE mutation, as well as the virulence of the isolate.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 37-year-old male was presented with productive cough and low-grade fever. The patient was diagnosed with CPA based on the chronic course, presence of a fungus ball in the upper left lobe on chest computed tomography (CT), positivity for <jats:italic>Aspergillus<\/jats:italic>-precipitating antibody and denial of other diseases. The patient underwent left upper lobe and left S6 segment resection surgery because of repeated haemoptysis during voriconazole (VRC) treatment. The patient was postoperatively treated with VRC for 6\u2009months. Since then, the patient was followed up without antifungal treatment but relapsed 4\u2009years later, and VRC treatment was reinitiated. Although an azole-resistant isolate was isolated after VRC treatment, the patient did not show any disease progression in either respiratory symptoms or radiological findings. The AR<jats:italic>Af<\/jats:italic> isolated from this patient showed slow growth, decreased biomass and biofilm formation in vitro, and decreased virulence in the <jats:italic>Galleria mellonella<\/jats:italic> infection model compared with its parental strain. These phenotypes could be caused by the HapE splice site mutation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This is the first to report a case demonstrating the clinical manifestation of a CPA patient infected with AR<jats:italic>Af<\/jats:italic> with a HapE splice site mutation, which was consistent with the in vitro and in vivo attenuated virulence of the AR<jats:italic>Af<\/jats:italic> isolate. These results imply that not all the AR<jats:italic>Af<\/jats:italic> infections in immunocompetent patients require antifungal treatment. Further studies on the virulence of non-<jats:italic>cyp51A<\/jats:italic> mutations in AR<jats:italic>Af<\/jats:italic> are warranted.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06279-1","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T19:02:47Z","timestamp":1623697367000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Clinical and experimental phenotype of azole-resistant Aspergillus fumigatus with a HapE splice site mutation: a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"Yuya","family":"Ito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-5386","authenticated-orcid":false,"given":"Takahiro","family":"Takazono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Koga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Ashizawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuro","family":"Hirayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Tashiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomi","family":"Saijo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuko","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Imamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiga","family":"Miyazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsunori","family":"Yanagihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Izumikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Mukae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,14]]},"reference":[{"key":"6279_CR1","doi-asserted-by":"crossref","unstructured":"Latge JP, Chamilos G. 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