Pulmonary Aspergillus sydowii Infection in a Patient with Pulmonary Hyalinizing Clear Cell Carcinoma: A Rare Case Report and Review of Reported Cases
- 1Department of Clinical Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China
- 2Department of Clinical Laboratory, Shenzhen Third People’s Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
Abstract
Background: Aspergillus sydowii, a member of Aspergillus series Versicolores, is widely distributed throughout the environment. Human infections are uncommon and usually superficial, whereas pulmonary disease has been reported only sporadically. Because phenotypic identification within series Versicolores is difficult and pulmonary disease may be indolent, the clinical significance of an A. sydowii respiratory isolate can be overlooked, particularly when distinguishing infection from colonization.
Case Presentation: We report the case of a 73-year-old woman with stage IV pulmonary hyalinizing clear cell carcinoma (HCCC) harboring an EWSR1::ATF1 fusion. She developed a persistent cough and sputum production after multimodal antitumor therapy and during prednisone treatment. Chest computed tomography (CT) showed right-upper-lobe bronchial dilatation and wall thickening with peribronchial patchy and nodular opacities. Laboratory results were unremarkable, except for lymphopenia; serum (1→3)-β-D-glucan and galactomannan assays were negative. A filamentous fungus recovered from bronchoalveolar lavage fluid (BALF) was identified as A. sydowii by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and internal transcribed spacer (ITS) sequencing. The same species was later isolated from sputum. Empirical fluconazole produced no improvement. Susceptibility testing showed a low voriconazole minimum inhibitory concentration (MIC) and a high fluconazole MIC, supporting a switch to oral voriconazole. The patient completed 8 weeks of treatment with therapeutic drug monitoring (TDM). Cough improved, sputum production resolved, CT abnormalities markedly improved, and follow-up fungal cultures were negative.
Conclusion: Aspergillus sydowii can cause clinically significant, indolent pulmonary infection in patients with solid tumors after chemoradiotherapy and corticosteroid exposure, even when serum inflammatory markers and fungal biomarkers are unremarkable. Repeated isolation, concordant species-level identification, and clinical, radiological, and mycological responses to susceptibility-guided voriconazole therapy with TDM supported infection rather than colonization and aided differentiation from radiation pneumonitis or tumor progression.
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BibTeX
@article{wu2026pulmonary,
title = {{Pulmonary Aspergillus sydowii Infection in a Patient with Pulmonary Hyalinizing Clear Cell Carcinoma: A Rare Case Report and Review of Reported Cases}},
author = {Weixing Wu and Qun Wang and Yanyu Xiao and Li Zhang},
journal = {Infection and Drug Resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s649592},
url = {https://doi.org/10.2147/idr.s649592},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Pulmonary Aspergillus sydowii Infection in a Patient with Pulmonary Hyalinizing Clear Cell Carcinoma: A Rare Case Report and Review of Reported Cases
AU - Weixing Wu
AU - Qun Wang
AU - Yanyu Xiao
AU - Li Zhang
PY - 2026
DA - 2026/10/30
JO - Infection and Drug Resistance
DO - 10.2147/idr.s649592
UR - https://doi.org/10.2147/idr.s649592
AB - Background: Aspergillus sydowii, a member of Aspergillus series Versicolores, is widely distributed throughout the environment. Human infections are uncommon and usually superficial, whereas pulmonary disease has been reported only sporadically. Because phenotypic identification within series Versicolores is difficult and pulmonary disease may be indolent, the clinical significance of an A. sydowii respiratory isolate can be overlooked, particularly when distinguishing infection from colonization. Case Presentation: We report the case of a 73-year-old woman with stage IV pulmonary hyalinizing clear cell carcinoma (HCCC) harboring an EWSR1::ATF1 fusion. She developed a persistent cough and sputum production after multimodal antitumor therapy and during prednisone treatment. Chest computed tomography (CT) showed right-upper-lobe bronchial dilatation and wall thickening with peribronchial patchy and nodular opacities. Laboratory results were unremarkable, except for lymphopenia; serum (1→3)-β-D-glucan and galactomannan assays were negative. A filamentous fungus recovered from bronchoalveolar lavage fluid (BALF) was identified as A. sydowii by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and internal transcribed spacer (ITS) sequencing. The same species was later isolated from sputum. Empirical fluconazole produced no improvement. Susceptibility testing showed a low voriconazole minimum inhibitory concentration (MIC) and a high fluconazole MIC, supporting a switch to oral voriconazole. The patient completed 8 weeks of treatment with therapeutic drug monitoring (TDM). Cough improved, sputum production resolved, CT abnormalities markedly improved, and follow-up fungal cultures were negative. Conclusion: Aspergillus sydowii can cause clinically significant, indolent pulmonary infection in patients with solid tumors after chemoradiotherapy and corticosteroid exposure, even when serum inflammatory markers and fungal biomarkers are unremarkable. Repeated isolation, concordant species-level identification, and clinical, radiological, and mycological responses to susceptibility-guided voriconazole therapy with TDM supported infection rather than colonization and aided differentiation from radiation pneumonitis or tumor progression.
SN - 1178-6973
ER -