Westerdykella Reniformis Masking as Histoplasmosis

IntroductionFungal infections contribute to significant morbidity and mortality in lung transplant patients. The incidence of a fungal infection is about 8.6% post transplant. Here, we present patient with by Westerdykella reniformis, mimicking as histoplasmosis.Case ReportA 65-year-old male 2 years bilateral presented recurrent low-grade fevers, for over month. His immunosuppression included tacrolimus, belatacept, azathioprine prednisone. On presentation, did give history working on chicken coops. Physical exam was benign. Work up pancytopenia, ground-glass density the left lower lobe anteromedial segment 5 mm subpleural nodule right middle lateral segment. Serum galactomannan and1,3 Beta D glucan were elevated. Urine histoplasma Ag high. BAL cytology showed organisms, however, could not be definitively identified. Galactomannan negative. Based above testing, received Abelcet followed Itraconazole histoplasmosis. With treatment, fever resolved, blood cell counts improved, urine antigen trended down. However, further testing species at Fungus Testing Laboratory, DNA probe negative histoplasmosis cultures revealed reniformis.SummaryWesterdykella an ascomycete fungus, ubiquitously soil plant material. About 10 have been identified date several them exist asexual Phoma anamorph state. There sporadic reports related immunocompromised A case angionvasive from dispersa reported bone marrow patient, who fever, neutropenia, skin lesions pulmonary nodules, which resolved anti-fungal therapy. To our knowledge, this first report westerdykella Fungal reniformis. Tabled 1Westerdykella reniformis Susceptibility TestingDrugMICAnidulafungin<=0.015 ug/mlNo CLSI interpretation availableCaspofungin<=0.015 availableFluconazole16 availableIsavuconazole0.5 availableItraconazole0.125 availableMicafungin<=0.015 availablePosaconazole0.125 availableVoriconazole0.125 available Open table new tab