case_images: PMC11387208_01
case_images: Chest imaging findings on admission. Chest radiograph showing the collapse of the left lower lung (A). High-resolution CT showing high-attenuation mucus (HAM) in the lower lobe bronchus (B, C) and left lobe atelectasis (D, E). Mucus plugs in the sputum (F).
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case_images: PMC11387208_01_gr1.jpg
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case_images: Chest imaging revealed decreased opacity in the left lower lung field (Fig. 1A) with CT showing atelectasis in the left lower lobe and high-attenuation mucus (HAM) in the left lower lobe bronchus (Fig. 1B-E). The expectorated mucus plug revealed abundant eosinophils with a positive culture for Scedosporium sp. (Fig. 1F), which was genetically identified as S. apiospermum at Chiba University Medical Mycology Research Center.
case_images: Bronchoscopic findings showing a yellowish-white mucus plug in the left main bronchus (A). The plugs were very viscous, making it difficult to remove all of them with suction and forceps using bronchoscopy (B). The mucus plugs remained in the left inferior lobe branch due to complications of airway mucosal edema and decreased SpO2 (C). Histopathological findings for mucus plugs using haematoxylin and eosin staining. The specimen shows a cluster of eosinophils and Charcot-Leyden crystals (D). Histopathological findings of the mucus plug using Grocott's stain. The specimen shows mycelia (E).
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case_images: Bronchoscopy performed on the second day of hospitalization revealed mucus plugs in the left main bronchus, hindering visualization of the left secondary bronchus (Fig. 2A). Attempts to remove the plugs using suction and forceps (Fig. 2B) was partly successful, but residual plugs remained due to airway mucosal edema, causing decreased SpO2 (Fig. 2C), and methylprednisolone (mPSL) 125 mg was administered. Pathological examination revealed numerous eosinophils (Fig. 2D) and positive filamentous fungi staining in the plugs (Fig. 2E).
case_images: Clinical course of the case. Arrow indicates methylprednisolone (mPSL). Bars indicate the duration of prednisolone (PSL) and antifungal treatment (VRCZ, voriconazole; PSCZ, posaconazole), and arrows correspond to the isolation of Scedosporium sp. in sputum cultures. The presence (+) or absence (-) of Scedosporium sp. isolation in sputum culture.
case_images: gr3.jpg
case_images: PMC11387208_01_gr3.jpg
case_images: fig3
case_images: Prednisolone at 20 mg/day (0.6 mg/kg/day) initially failed for 1 week; thus, it increased to 40 mg/day alongside voriconazole (VRCZ), yielding symptom, eosinophil count, and imaging findings (Fig. 3).