title: Phellinus species: An emerging cause of refractory fungal infections in patients with X-linked chronic granulomatous disease.
abstract: Aspergillus spp. are a leading cause of mortality in chronic granulomatous disease (CGD), but other fungi have emerged in the era of mould prophylaxis. Of these, Phellinus spp. are an under-recognised cause of invasive fungal infections (IFIs) in CGD, and data on their presentation and management are scarce. We present a patient with CGD who developed disseminated IFI involving the lungs and brain. Surgical specimens grew a basidiomycete which was disregarded as a contaminant. After three months of progressive disease despite antifungals, he was diagnosed with Phellinus tropicalis by internal transcribed spacer (ITS) sequencing. He improved with amphotericin B and isavuconazole but required haematopoietic stem cell transplantation (HSCT). We review the literature on Phellinus infections in CGD and conclude that: (i) these infections emerge on mould-active prophylaxis and are indolent; (ii) they typically cause locally destructive disease but can disseminate; (iii) diagnosis is delayed and requires molecular methods; (iv) amphotericin B is most active in vitro; and (v) treatment is protracted and requires surgery and possibly HSCT. In conclusion, Phellinus spp. are emerging pathogens in CGD. Every effort should be made to establish the diagnosis of non-Aspergillus IFIs in patients with CGD by sending tissue specimens for molecular diagnostics.
authors: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Ghady
authors: http://orcid.org/0000-0003-0634-8211
authors: G
authors: Haidar
authors: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
authors: Christa S
authors: CS
authors: Zerbe
authors: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Michelle
authors: M
authors: Cheng
authors: Department of Laboratory Medicine, Microbiology Service, National Institutes of Health, Bethesda, MD, USA.
authors: Adrian M
authors: AM
authors: Zelazny
authors: Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
authors: Steven M
authors: SM
authors: Holland
authors: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Kathleen R
authors: KR
authors: Sheridan
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001487:Basidiomycota / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001921:Brain / Q000382:microbiology; D021903:DNA, Ribosomal Spacer; D006105:Granulomatous Disease, Chronic / Q000150:complications* / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000072742:Invasive Fungal Infections / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000382:microbiology*; D008168:Lung / Q000382:microbiology; D008297:Male; D009570:Nitriles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D021903:DNA, Ribosomal Spacer; D009570:Nitriles; D011725:Pyridines; D014230:Triazoles; C508735:isavuconazole; D000666:Amphotericin B
keywords: 
  Phellinus
  ; basidiomycota; chronic granulomatous disease; internal transcribed spacer