A rare case of scedosporium apiospermum osteomyelitis in an immunocompetent patient

• Published in: IDCases 2024-01, Vol.35, p.e01929, Article e01929
• Main Authors: Rajani, Aayushi J., Raval, Darshankumar, Chitale, Rohit, Durvasula, Ravindra, Oring, Justin, Powers, Ross
• Format: Article
• Language: English
• Subjects: Case Report; Caspofungin; Dual antifungal therapy; Scedosporium Apiospermum; Voriconazole
• ISSN: 2214-2509; 2214-2509
• DOI: 10.1016/j.idcr.2024.e01929

Scedosporium, a widespread filamentous fungus found in diverse environments, has experienced a rise in cases due to escalating malignancies and chronic immunosuppression. Clinical manifestations span mycetoma, airway involvement, and various infections, with osteomyelitis being a notable complication. We present a case of a 77-year-old female initially displaying cutaneous Scedosporium signs, which progressed to osteomyelitis. The patient, with a history of trauma, chronic low dose steroid use, and underlying conditions, presented with a foot injury caused by her dog. Despite initial management, worsening symptoms led to the identification of Scedosporium. A comprehensive approach involving debridement, antimicrobial therapy, and reduction of immunosuppression resulted in clinical improvement. The rarity of zoonotic transmission, diagnostic challenges, and antifungal efficacy are also discussed. The patient's positive trajectory emphasizes early diagnosis, targeted treatment, and vigilance in managing immunosuppression. An adaptable treatment protocol is proposed based on risk factors. Considering the rising opportunistic fungal infections and delayed culture results, initiating empirical antifungals based on clinical judgment and regional prevalence is vital for favorable outcomes.