2025 Volume 14 Issue 5 Pages 233-236
A 77-year-old immunocompetent man without a history of drowning or trauma had experienced chronic cough and sputum production for 20 years. The patient was referred for further evaluation after an abnormality was detected on a chest X-ray during a routine health examination. A CT scan revealed multiple nodular opacities and mucus plugs with associated bronchiectasis. S. apiospermum was repeatedly isolated from sputum, and filamentous fungi were observed on bronchial brushing cytology; therefore, probable S. apiospermum airway infection was suspected, and oral voriconazole was initiated. After therapy, the patient’s symptoms and imaging findings improved; however, the isolate showed a voriconazole MIC >8 µg/mL, suggesting that factors other than drug activity (e.g., airway drainage) may have contributed to the clinical response. This case highlights the importance of obtaining fungal cultures in undiagnosed airway or pulmonary infections, even in immunocompetent individuals.
