Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report.
BACKGROUND
Scedosporium apiospermum is increasingly recognized as a cause of localized and disseminated mycotic infections in near-drowning victims.


METHODS
We report the case of a 59-year-old Japanese woman who was a survivor of a tsunami in northeastern Japan and who had lung and brain abscesses caused by S. apiospermum. Initially, an aspergillus infection was suspected, so she was treated with micafungin. However, computed tomography scans of her chest revealed lung abscesses, and magnetic resonance images demonstrated multiple abscesses in her brain. S. apiospermum was cultured from her bronchoalveolar lavage fluid, and antimycotic therapy with voriconazole was initiated. Since she developed an increase in the frequency of premature ventricular contractions, an adverse drug reaction to the voriconazole was suspected. She was started on a treatment of a combination of low-dose voriconazole and liposomal amphotericin B. After combination therapy, further computed tomography scans of the chest and magnetic resonance images of her brain showed a demarcation of abscesses.


CONCLUSIONS
Voriconazole appeared to have a successful record in treating scedosporiosis after a near drowning but, owing to several adverse effects, may possibly not be recommended. Thus, a combination treatment of low-dose voriconazole and liposomal amphotericin B may be a safe and effective treatment for an S. apiospermum infection. Even though a diagnosis of scedosporiosis may be difficult, a fast and correct etiological diagnosis could improve the patient's chance of recovery in any case.
Division of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 0208505, Japan. ICB75097@nifty.com.
Yutaka
Y
Nakamura
Yu
Y
Utsumi
Naomi
N
Suzuki
Yoshio
Y
Nakajima
Okinori
O
Murata
Nobuhito
N
Sasaki
Hiroo
H
Nitanai
Hiromi
H
Nagashima
Shinya
S
Miyamoto
Jun
J
Yaegashi
Tomoki
T
Hatakeyama
Yoshihiro
Y
Shibano
Kyoko
K
Yarita
Katsuhiko
K
Kamei
Toshihide
T
Nakadate
Shigeatsu
S
Endo
Yasuo
Y
Terayama
Kohei
K
Yamauchi