[A case of bronchial infection of Wangiella dermatitidis].

A 81-year-old woman was admitted to our hospital because of bloody sputum. Chest radiograph showed an enhanced right pulmonary hilum shadow. Computed tomography (CT) revealed localized bronchiectasis of the right lower lung and a nodule protruding into the bronchus. A parenchymal shadow was also seen distal to the nodule. Transbronchial biopsy revealed a cluster of yeast-like fungi and the bronchial lavage culture showed several olive-black colored colonies on Sabouraud agar. Before culture, we empirically administered fluconazole (400 mg/day) on the assumption of candida infection based on the yeast like microscopic findings, however that was not appropriate. Substitution by itraconazole (200 mg/day) made a slight improvement of the shadow on CT. Later polymerase chain reaction of specimens taken by TBLB identified the olive-black fungus as Wangiella dermatitidis. W. dermatitidis is a dematicious fungus sometimes causing tinea nigra or subcutaneous infection. In compromised patients, it causes phaeohyphomycosis especially in the central nerve system. In cystic fibrosis patients, this fungus is recognized to colonize the respiratory tract and rarely causes pneumonia. This case had no previous immunosuppressing disease, except for localized bronchiectasis which was found by CT on admission. We think this is a very rare W. dermatitidis infection case showing a nodular lesion in an immunocompetent patient.