Importance of Identifying Pathogenic Causes of Infection in Lung Abscess in Chronic Granulomatous Disease
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Megan Goebel, MD, Peter Mustillo, MD FAAAAI
Rationale: To demonstrate the importance of identifying pathogens in patients affected with Chronic Granulomatous Disease (CGD)

Methods: Background:Patients affected with CGD are known to have increased susceptibility to catalase-producing pathogens. The five best characterized disease-causing-organisms in these patients include S. aureus, Nocardia, Serratia, Burkholderia, and aspergillus. Especially in recent years, numerous other pathogens have also been identified, including rare species of fungi and unusual bacteria. Implications of identification are extensive and often help direct specific therapies.

Results: Presentation: A 22 year old male with X-CGD with prior history of numerous infections including Nocardia pneumonia, MRSA liver abscess, serratia cellulitis and anterior mediastinal lymphadenitis presented with cervical lymphadenitis.  CT of the neck and chest demonstrated a new 11x16 mm right middle lobe lung lesion. This had not been present on imaging 3 months prior, and developed while on prophylactic voriconazole and Bactrim, albeit with suboptimal adherence. Biopsy of the nodule led to identification of Cladophialophora bantiana. This organism is known to cause potentially severe and fatal disease, with reported cases spreading to the CNS with risk of cerebral phaeohyphomycosis. 

Conclusions: Cladophialophora bantiana is yet another organism causing serious morbidity in CGD patients that can be difficult to treat, require multiple antifungal agents and even lesion resection. Our patient did not respond to amphotericin and voriconazole. This case emphasizes the importance of identifying the pathogen causing an infection whenever possible in CGD patients – to target therapy, direct need for antimicrobial combinations, assess for co-infections, and be aware of other potential co-morbidity risks such as dissemination.