A Fatal Case of Pulmonary Penicilliosis

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A 19-year-old male developed acute lymphocytic leukemia complicated with pulmonary penicilliosis. Marked leukopenia with a high fever continued for more than two weeks. A strain of Candida glabrata was isolated from blood culture. Treatment was initiated by combination therapy with antifungal drugs and anticancer drugs. To treat the suspected infection with this fungus, oral flucytosine and intravenous miconazole were administered, but the clinical symptoms were not alleviated. Thus oral fluconazole was added to the regimen. X-ray examinations revealed that the infiltration in the middle and lower fields of the right lung gradually became localized, and the findings suggested the formation of a fungus ball. The patient died of right pneumothorax on the 66th hospital day.
At autopsy, mass lesions were detected in the thoracic cavity about 4×4×5cm in size in the right middle lobe and about 1×1×3cm in size in the left upper lobe. These mass lesions were filled with necrotic lung tissues, and they thus differed in nature from the so-called fungus ball. Those lesions and the cavity wall contained numerous fungal elements consisting of dichotomous septated hyphae. Two morphologically different fungi were isolated from the mass lesion in the right lung : one isolate was identified as Penicillium citrinum and the other was a Penicillium species without reaching the final identification. The morphology of these two isolates was examined in detail with an electron microscope.
This seems to be the first reported case of pulmonary penicilliosis due to P. citrinum and an unidentified Penicillium sp.