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A5386 - Ochroconis Gallopava Infection in a Patient with Bronchiectasis on Low Dose Steroids
Author Block: C. Whitehurst, C. Patel, C. Boethel; Baylor Scott and White Health, Temple, TX, United States.
Ochroconis gallopava (also known as Dactylaria gallopava and Dactylaria constricta var. gallopava) is a ubiquitous fungus found in hot spring environments, soil, wood, and decaying vegetation that targets immunocompromised patients especially those who have undergone transplant causing life threatening infection5. There are many sites that this pathogen can induce infection such as central nervous system, skin, with pulmonary involvement noted to be the most common2. This is a case of a 77-year-old woman with a past medical history of chronic bronchiectasis and adrenal insufficiency on chronic, low-dose steroids presenting with hemoptysis, progressive dyspnea on exertion, and increased fatigue. She was a non-smoker with no prior history of tobacco use. She had no significant occupational or environmental exposure history. Physical exam was pertinent for a thin, elderly female with coarse breath sounds bilaterally. She had been evaluated in the pulmonary clinic two months prior due to non-productive cough and underwent bronchoscopy with bronchial alveolar lavage (BAL). These studies were negative without evidence of acid-fast or bacterial pathogens. Her fungal culture from the BAL resulted just prior to her presentation for hemoptysis, revealing Ochroconis gallopava infection. Laboratory examination revealed an elevated white blood cell count of 14,600/mm3. Procalcitonin was below assay; blood cultures and respiratory virus panel were negative. Chest x-ray revealed bilateral upper lobe bronchiectasis with stable biapical pleural thickening. CT angiogram of the chest revealed several mildly hypertrophied bronchial arteries bilaterally without evidence of active hemorrhage or aneurysm, prominent bronchiectasis greatest in the bilateral upper lobes, and scattered consolidation with nodular and tree in bud opacities. MRI brain was negative for CNS involvement. The patient was started on itraconazole with resolution of symptoms after five months of therapy. Ochroconis infections have been primarily limited to immunocompromised hosts with history of solid-organ transplantation or hematologic malignancy. There are few reported cases of Ochroconis infection in immunocompetent patients3. This case demonstrates a pulmonary infection in an immunocompetent host, thought to be secondary to chronic, low-dose steroid use. To our knowledge, this is the first case of a pulmonary infection in an immunocompetent patient with adrenal insufficiency on chronic, low-dose steroids.