{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:52:59Z","timestamp":1793832779952,"version":"4.6.1"},"reference-count":33,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Ricerca corrente 5\u00d71000-2020","award":["090000\u00d7121\u2014progetto 08050122"],"award-info":[{"award-number":["090000\u00d7121\u2014progetto 08050122"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background:\u00a0Scedosporium apiospermum is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic resistance to multiple antifungal agents. Case Presentation: We report the case of a 66-year-old immunocompetent woman with idiopathic bilateral non-cystic fibrosis bronchiectasis, who presented with subacute cough and increased sputum production. Chest high-resolution CT revealed new subsolid and ground-glass infiltrates superimposed on stable bronchiectatic changes. Bronchoalveolar lavage (BAL) cultures isolated S. apiospermum as the sole pathogen. The patient was treated with oral voriconazole (200 mg BID) for 4 weeks, followed by a 4-week course of aerosolized amphotericin B. Clinical and radiological improvement was observed, and no relapse occurred during follow-up. Discussion: This case highlights the potential for S. apiospermum to cause clinically relevant pulmonary infection in structurally abnormal but immunocompetent lungs. Non-CF bronchiectasis may facilitate fungal colonization due to impaired mucociliary clearance and chronic mucus retention. Combined antifungal therapy involving systemic voriconazole and inhaled amphotericin B (though not yet standardized) was employed based on clinical rationale and the available literature, resulting in favorable outcomes. Conclusions:S. apiospermum pulmonary infection, although rare in immunocompetent hosts with bronchiectasis, should be considered in cases of new or persistent infiltrates. Early recognition and individualized antifungal strategies, including the potential role of inhaled agents, may improve clinical outcomes. This case reinforces the importance of multidisciplinary collaboration in the management of complex fungal infections in chronic airway disease.<\/jats:p>","DOI":"10.3390\/jcm14165914","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T15:19:02Z","timestamp":1755789542000},"page":"5914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pulmonary Infiltrates in a Non-Cystic Fibrosis Bronchiectasis Patient: A Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7699-6610","authenticated-orcid":false,"given":"Francesco Rocco","family":"Bertuccio","sequence":"first","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Baio","sequence":"additional","affiliation":[{"name":"Ospedale Maggiore, ASST Crema, 26013 Crema, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Montini","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Ferroni","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Chino","sequence":"additional","affiliation":[{"name":"Ospedale Pederzoli, Peschiera del Garda, 37121 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucrezia","family":"Pisanu","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Russo","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Giana","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Gallo","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9805-5205","authenticated-orcid":false,"given":"Lorenzo","family":"Arlando","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klodjana","family":"Mucaj","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitela","family":"Tafa","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6875-3987","authenticated-orcid":false,"given":"Maria","family":"Arminio","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"De Stefano","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5725-5309","authenticated-orcid":false,"given":"Alessandro","family":"Cascina","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo Guido","family":"Corsico","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0929-4394","authenticated-orcid":false,"given":"Giulia Maria","family":"Stella","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Conio","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Disease, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy"},{"name":"Department of Internal Medicine and Pharmacology, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4930","DOI":"10.1128\/JCM.43.10.4930-4942.2005","article-title":"Molecular Phylogeny of the Pseudallescheria Boydii Species Complex: Proposal of Two New Species","volume":"43","author":"Gilgado","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1128\/JCM.01122-07","article-title":"Molecular and Phenotypic Data Supporting Distinct Species Statuses for Scedosporium apiospermum and Pseudallescheria boydii and the Proposed New Species Scedosporium dehoogii","volume":"46","author":"Gilgado","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1128\/CMR.00039-07","article-title":"Infections Caused by Scedosporium spp","volume":"21","author":"Cortez","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1136\/jcp.2003.8680","article-title":"Infection of the CNS by Scedosporium apiospermum after near Drowning. Report of a Fatal Case and Analysis of Its Confounding Factors","volume":"57","author":"Kowacs","year":"2004","journal-title":"J. Clin. Pathol."},{"key":"ref_5","first-page":"917","article-title":"Infections Caused by Scedosporium\/Lomentospora Species: Clinical and Microbiological Findings in 21 Cases","volume":"56","author":"Cobo","year":"2018","journal-title":"Med. Mycol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e17535","DOI":"10.1097\/MD.0000000000017535","article-title":"Scedosporium Spp. Lung Infection in Immunocompetent Patients: A Systematic Review and MOOSE-Compliant Meta-Analysis","volume":"98","author":"Liu","year":"2019","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s00381-005-1151-3","article-title":"Successful Treatment of Multiple Pseudallescheria boydii Brain Abscesses and Ventriculitis\/Ependymitis in a 2-Year-Old Child after a near-Drowning Episode","volume":"22","author":"Mursch","year":"2006","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_8","first-page":"1697","article-title":"Mycotic Aneurysms as Lethal Complication of Brain Pseudallescheriasis in a Near-Drowned Child: A CT Demonstration","volume":"23","author":"Messori","year":"2002","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1128\/AAC.46.1.62-68.2002","article-title":"In Vitro Activities of New and Conventional Antifungal Agents against Clinical Scedosporium Isolates","volume":"46","author":"Meletiadis","year":"2002","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1128\/AAC.05910-11","article-title":"Species-Specific Antifungal Susceptibility Patterns of Scedosporium and Pseudallescheria Species","volume":"56","author":"Lackner","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","first-page":"102256","article-title":"Clinical Characterization of Immunocompetent Patients with Scedosporium Detected in Respiratory Samples: A Case Series","volume":"57","author":"Ito","year":"2025","journal-title":"Respir. Med. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.riam.2011.04.002","article-title":"Clinical Characteristics and Epidemiology of Pulmonary Pseudallescheriasis","volume":"29","author":"Guarro","year":"2012","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"415","DOI":"10.3892\/or.2013.2800","article-title":"Lymph Node Involvement and Metastatic Lymph Node Ratio Influence the Survival of Malignant Pleural Mesothelioma: A French Multicenter Retrospective Study","volume":"31","author":"Hysi","year":"2014","journal-title":"Oncol. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1186\/s12879-024-09140-3","article-title":"Diagnosis of Pulmonary Scedosporium apiospermum Infection from Bronchoalveolar Lavage Fluid by Metagenomic Next-Generation Sequencing in an Immunocompetent Female Patient with Normal Lung Structure: A Case Report and Literature Review","volume":"24","author":"Han","year":"2024","journal-title":"BMC Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chen, S.C.-A., Halliday, C.L., Hoenigl, M., Cornely, O.A., and Meyer, W. (2021). Scedosporium and Lomentospora Infections: Contemporary Microbiological Tools for the Diagnosis of Invasive Disease. J. Fungi, 7.","DOI":"10.3390\/jof7010023"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"myae002","DOI":"10.1093\/mmy\/myae002","article-title":"Detection of Scedosporium spp.: Colonizer or Pathogen? A Retrospective Analysis of Clinical Significance and Management in a Large Tertiary Center","volume":"62","author":"Reinhold","year":"2024","journal-title":"Med. Mycol."},{"key":"ref_17","first-page":"e16891","article-title":"Scedosporium Apiospermum Pneumonia in an Immunocompetent Host","volume":"13","author":"Mir","year":"2021","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12931-025-03140-w","article-title":"Pulmonary Microbiology and Microbiota in Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and Meta-Analysis","volume":"26","author":"Wang","year":"2025","journal-title":"Respir. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"M\u00e1iz, L., Nieto, R., Cant\u00f3n, R., de la Pedrosa, E., and Martinez-Garc\u00eda, M.\u00c1. (2018). Fungi in Bronchiectasis: A Concise Review. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19010142"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.3109\/13693786.2010.499374","article-title":"Newer Combination Antifungal Therapies for Invasive Aspergillosis","volume":"49","author":"Steinbach","year":"2011","journal-title":"Med. Mycol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1128\/AAC.01388-07","article-title":"Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients","volume":"52","author":"Troke","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_22","first-page":"589490","article-title":"Combination Antifungal Therapy in the Treatment of Scedosporium apiospermum Central Nervous System Infections","volume":"2013","author":"Barron","year":"2013","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"McCarthy, M.W., Katragkou, A., Iosifidis, E., Roilides, E., and Walsh, T.J. (2018). Recent Advances in the Treatment of Scedosporiosis and Fusariosis. J. Fungi, 4.","DOI":"10.3390\/jof4020073"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Vuong, N.N., Hammond, D., and Kontoyiannis, D.P. (2023). Clinical Uses of Inhaled Antifungals for Invasive Pulmonary Fungal Disease: Promises and Challenges. J. Fungi, 9.","DOI":"10.3390\/jof9040464"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1517\/14740330903036083","article-title":"Inhaled Therapeutics for Prevention and Treatment of Pneumonia","volume":"8","author":"Safdar","year":"2009","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S161","DOI":"10.1016\/S0924-8579(08)70019-0","article-title":"Invasive Fungal Infections in Lung Transplantation: Role of Aerosolised Amphotericin B","volume":"32","year":"2008","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Brunet, K., Martellosio, J.-P., Tewes, F., Marchand, S., and Rammaert, B. (2022). Inhaled Antifungal Agents for Treatment and Prophylaxis of Bronchopulmonary Invasive Mold Infections. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14030641"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1128\/AAC.01657-08","article-title":"3rd Inhaled Voriconazole for Prevention of Invasive Pulmonary Aspergillosis","volume":"53","author":"Tolman","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e0063821","DOI":"10.1128\/AAC.00638-21","article-title":"Activity of Amphotericin B Formulations and Voriconazole, Alone or in Combination, against Biofilms of Scedosporium and Fusarium spp","volume":"65","author":"Vikelouda","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s11845-010-0621-0","article-title":"Pneumothorax and Empyema Complicating Scedosporium apiospermum Mycetoma: Not Just a Problem in the Immunocompromised Patients","volume":"180","author":"Hassan","year":"2011","journal-title":"Ir. J. Med. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"472","DOI":"10.4067\/S0716-10182015000500018","article-title":"Pulmonary non invasive infection by Scedosporium apiospermum","volume":"32","author":"Cruz","year":"2015","journal-title":"Rev. Chil. Infectol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1093\/cid\/cir004","article-title":"A 61 Year-Old Female with a Prior History of Tuberculosis Presenting with Hemoptysis","volume":"52","author":"Durand","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"435","DOI":"10.4103\/ijmy.ijmy_98_20","article-title":"Diagnosis of Atypical Mycobacterial and Fungal Coinfection","volume":"9","author":"Jimeno","year":"2020","journal-title":"Int. J. Mycobacteriology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5914\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:07Z","timestamp":1760034787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,21]]},"references-count":33,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165914"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165914","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,21]]}}}