title: Fatal pneumonia caused by Penicillium digitatum: a case report.
abstract: BACKGROUND
  Penicillium species are among the most common fungi present in the environment and are usually considered non-pathogenic to humans. However, in immunocompromised hosts they can be virulent pathogens and can cause death. Penicillium digitatum is a plant pathogen that commonly causes a postharvest fungal disease of citrus called green mould; it very rarely causes systemic mycosis in humans. Here, we report a case of fatal pneumonia due to P. digitatum infection, as confirmed by repeated examination of cultured sputum.
  
  
  METHODS
  A cavity was found in the left upper lung on routine chest X-ray in a 78-year-old undernourished male who had been diagnosed at age 66 with bronchial asthma and pulmonary emphysema. No increased sputum production was present. The presence of antigen-specific precipitating antibodies to Aspergillus flavus and P. digitatum was confirmed in the patient's serum and also later pleural fluid by using Ouchterlony double immunodiffusion testing with A. flavus and P. digitatum antigens. The patient was treated over a period of months with itraconazole, micafungin, voriconazole, amphotericin B, and antibacterials. However, the cavity enlarged, the pleural effusion increased, and the patient began producing purulent sputum. He died from progressive renal failure. From sputum culture only one fungus was isolated repeatedly on potato-dextrose agar in large quantities. This fungus was confirmed to be P. digitatum by molecular identification. Partial sequences of the beta-tubulin gene were determined by using the primers Bt2a and Bt2b for PCR amplification and sequencing and underwent a BLAST search at the National Centre for Biotechnology Information, these results confirmed that the isolated fungus was P. digitatum.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of pulmonary infection with P. digitatum. Our patient had pulmonary emphysema and was elderly, and undernourished. These factors might have facilitated the infection. In his case, antimycotics were ineffective in treating the lung involvement. Although human infection with P. digitatum is considered rare, it appears that this organism can be very virulent and resistant to antimycotics.
authors.affiliation: Clinical Research Centre for Allergy and Rheumatology, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan.
authors.forename: Chiyako
authors.initials: C
authors.lastname: Oshikata
authors.forename: Naomi
authors.initials: N
authors.lastname: Tsurikisawa
authors.forename: Akemi
authors.initials: A
authors.lastname: Saito
authors.forename: Maiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kamata
authors.forename: Maki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuburai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mitomi
authors.forename: Kosuke
authors.initials: K
authors.lastname: Takatori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasueda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Akiyama
mesh_terms: D000368:Aged; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications; D009181:Mycoses / Q000150:complications / Q000382:microbiology*; D010407:Penicillium / Q000302:isolation & purification*; D011014:Pneumonia / Q000150:complications / Q000382:microbiology*; D011656:Pulmonary Emphysema / Q000150:complications; D013183:Sputum / Q000382:microbiology