title: Pseudallescheria Boydii pneumonia in an immunocompetent host.
abstract: BACKGROUND
  Pseudallescheria boydii pneumonia is rarely reported among immunocompetent patients.
  
  
  METHODS
  We report a case of a 62 year old white female with pseudallescheria boydii pneumonia. The patient was non-immunocompromised, had a history of mycobacterium avium complex (MAC) infection prior to presentation. After successful response to initial antitubercular therapy, the patient developed recurrent symptoms and bibasilar nodular infiltrates. Second line therapy for MAC failed to improve symptomatology. Pseudallescheria boydii pneumonia was diagnosed from a bronchoscopic biopsy. Treatment with voriconazole resolved her symptomatology and radiological infiltrates.
  
  
  CONCLUSIONS
  This case highlights the importance of a high index of suspicion for superimposed fungal infections in patients who are refractory to medical treatment of bacterial pneumonitis such as MAC. Further diagnostic interventions are encouraged when insufficient clinical improvement is observed. Prompt initiation of an antifungal regimen is warranted.
authors.affiliation: Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, U.S.A.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Cumbo-Nacheli
authors.forename: Jorgelina
authors.initials: J
authors.lastname: de Sanctis
authors.forename: David
authors.initials: D
authors.lastname: Holden
keywords: Pseudallescheria Boydii; immunocompetent host; pneumonia