Scedosporium apiospermum lung disease in a patient with nontuberculous mycobacteria

Although tuberculosis is a major underlying cause of pulmonary mycetoma due to Scedosporium apiospermum, little is known about coinfection with nontuberculous mycobacteria (NTM) and S. apiospermum. A 67-year-old man with NTM presented with recurrent haemoptysis. Computed tomography of the chest revealed pulmonary mycetoma in the left upper lobe of the lung, and culture of bronchial washing fluid yielded S. apiospermum. Oral voriconazole therapy ameliorated both haemoptysis and mycetoma findings. As far as we are aware, this is the first reported case of S. apiospermum lung disease in a patient with NTM but without tuberculosis. The possibility of S. apiospermum infection should thus be considered in the differential diagnosis of pulmonary mycetoma. Although S. apiospermum mycetoma resembles aspergilloma, antifungal strategies for these two conditions differ, with the collection of culture specimens such as by bronchoscopy being compulsory for accurate diagnosis and appropriate management of S. apiospermum infection.