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case_images: (A-B) Chest computed tomography (CT) revealed a nodular shadow at the base of the right lung five months after the diagnosis of anti-MDA5 antibody-positive dermatomyositis (day 0). (C-D) Three weeks after starting voriconazole (day 22), CT showed a reduction in the size of the known lesion in the right middle lobe, but a new cavitary shadow appeared in the left upper lobe. (E-F) CT after initiating ampicillin-sulbactam and amphotericin B (day 48) showed worsening of the cavitary shadow in the left upper lobe. (G-H) CT one month after the addition of terbinafine (day 65) showed improvement in the cavitary shadow in the left upper lobe.
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case_images: Chest CT scan revealed that the known lesion in the right middle lobe was reduced in size, but a new cavitary shadow appeared in the left upper lobe [Fig. 1C and D]. The cavity shadow worsened after treatment was changed [Fig. 1E and F], and sputum culture tests were submitted repeatedly. Eleven days after the switch to liposomal amphotericin B (day 47), multiple sputum cultures revealed the presence of filamentous fungi, with Lomentospora prolificans suspected based on morphology and antifungal susceptibility [Fig. 2 and Table 1]. TBF 125 mg a day was added (day 50), assuming VRC-resistant Lomentospora prolificans, resulting in a reduction of the cavity shadow on chest CT [Fig. 1G and H].
case_images: Lomentospora prolificans in sputum cultures. The sputum cultures revealed the presence of filamentous fungi suspected to be Lomentospora prolificans. (A) Macrophotograph of the fungal colony. (B) Micrograph of fungi isolated from the colony.
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case_images: Eleven days after the switch to liposomal amphotericin B (day 47), multiple sputum cultures revealed the presence of filamentous fungi, with Lomentospora prolificans suspected based on morphology and antifungal susceptibility [Fig. 2 and Table 1].