Abstract：
BACKGROUND: Schizophyllum commune (S. commune) is an opportunistic pathogenic fungus and can cause infection of the respiratory system in immunocompromised hosts. Allergic bronchopulmonary mycosis (ABPM) is the major disease caused by S. commune. However, identification of S. commune using routine mycological diagnostic methods is difficult. It is easy to make mistakes in diagnosis and treatment, resulting in deterioration of the disease. We report the first case of ABPM due to S. commune in a Chinese patient with chronic hepatitis B.
METHODS: The patient presented cough, sputum and dyspnea for six months. The pathogen was missed during routine laboratory workup. We performed bronchoscopy examination and bronchoalveolar lavage. S. commune was identified by metagenomic next-generation sequencing (mNGS) of bronchial alveolar lavage fluid (BALF). Hence, the patient was immediately treated with 200 mg voriconazole twice daily (intravenous infusion) and 20 mg prednisone once a day (oral therapy), along with oral entecavir for hepatitis B. There was no recurrence of infection after the medication was discontinued.
CONCLUSIONS: S. commune infection should be considered in the diagnosis of patients with refractory cough, sputum and dyspnea, especially in immunocompromised individuals. The mNGS technique is an effective supplementary technique for the diagnosis of S. commune infection, enabling precise clinical decision-making and appropriate treatment. Most patients have good prognosis with a combination of proper antifungal therapy and hormonal therapy.
METHODS: The patient presented cough, sputum and dyspnea for six months. The pathogen was missed during routine laboratory workup. We performed bronchoscopy examination and bronchoalveolar lavage. S. commune was identified by metagenomic next-generation sequencing (mNGS) of bronchial alveolar lavage fluid (BALF). Hence, the patient was immediately treated with 200 mg voriconazole twice daily (intravenous infusion) and 20 mg prednisone once a day (oral therapy), along with oral entecavir for hepatitis B. There was no recurrence of infection after the medication was discontinued.
CONCLUSIONS: S. commune infection should be considered in the diagnosis of patients with refractory cough, sputum and dyspnea, especially in immunocompromised individuals. The mNGS technique is an effective supplementary technique for the diagnosis of S. commune infection, enabling precise clinical decision-making and appropriate treatment. Most patients have good prognosis with a combination of proper antifungal therapy and hormonal therapy.
摘要：
背景：Schizophyllumcommunee(S.commune）是一种机会致病性真菌，可引起免疫功能低下的宿主的呼吸系统感染。过敏性支气管肺真菌病（ABPM）是由S.commune引起的主要疾病。然而,使用常规真菌学诊断方法很难鉴定S.commune。在诊断和治疗上容易出错,导致疾病恶化。我们报告了中国慢性乙型肝炎患者中首例由S.commune引起的ABPM。
方法：患者出现咳嗽，痰和呼吸困难六个月。在常规实验室检查期间错过了病原体。我们进行了支气管镜检查和支气管肺泡灌洗。通过支气管肺泡灌洗液（BALF）的宏基因组下一代测序（mNGS）鉴定了美国公社。因此，患者立即接受200mg伏立康唑每天两次（静脉输注）和20mg泼尼松每天一次（口服治疗）治疗，同时口服恩替卡韦治疗乙型肝炎，停药后无感染复发。
结论：S.难治性咳嗽患者的诊断应考虑社区感染，痰和呼吸困难，尤其是在免疫受损的个体中。mNGS技术是诊断S.commune感染的有效辅助技术，实现精确的临床决策和适当的治疗。结合适当的抗真菌治疗和激素治疗，大多数患者预后良好。
方法：患者出现咳嗽，痰和呼吸困难六个月。在常规实验室检查期间错过了病原体。我们进行了支气管镜检查和支气管肺泡灌洗。通过支气管肺泡灌洗液（BALF）的宏基因组下一代测序（mNGS）鉴定了美国公社。因此，患者立即接受200mg伏立康唑每天两次（静脉输注）和20mg泼尼松每天一次（口服治疗）治疗，同时口服恩替卡韦治疗乙型肝炎，停药后无感染复发。
结论：S.难治性咳嗽患者的诊断应考虑社区感染，痰和呼吸困难，尤其是在免疫受损的个体中。mNGS技术是诊断S.commune感染的有效辅助技术，实现精确的临床决策和适当的治疗。结合适当的抗真菌治疗和激素治疗，大多数患者预后良好。
