title: Phanerochaete chrysosporium and granulomatous lung disease in a mulch gardener.
abstract: A 50-year-old woman who gardens regularly with rotting bark mulch presented with exertional dyspnea, diffusion impairment, and radiographic abnormalities (centrilobular nodules, tree-in-bud and ground glass opacities, calcified mediastinal and hilar lymph nodes) on a computed tomogram. Moderate lymphocytosis was noted on bronchoalveolar lavage. Surgical biopsy of her lung revealed granulomatous changes, and biopsies grew Phanerochaete chrysosporium, a fungus that causes white rot in tree bark. She was treated with voriconazole and instructed to avoid gardening, which led to radiographic and symptomatic improvement. She had recurrence of symptoms when she started doing yard work again. P. chrysosporium has been demonstrated to cause hypersensitivity pneumonitis in animal models. This case is the first documented report of P. chrysosporium associated with granulomatous lung disease in a human.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine Salt Lake City, Utah ; Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center Salt Lake City, Utah.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lanspa
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine Salt Lake City, Utah.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Hatton
keywords: Clinical respiratory medicine; environmental and occupational health and epidemiology; fungus; infection and inflammation