Endobronchial Pseudallescheria boydii in lung transplant patient with cystic fibrosis

Emerging fungal pathogens in immunocompromised patients have recently challenged physicians. Aspergillus spp., Coccidioides immitis, Zygomycetes, Candida spp., and Cryptococcus neoformans are the most common fungal pathogens causing endobronchial involvement, with Aspergillus being by far the most common endobronchial pathogen in lung transplant recipients. Scedosporium spp. are considered emerging fungal pathogens and include 2 main human pathogens namely S. apiospermum, the asexual state of Pseudallescheria boydii (P. boydii), and S. prolificans. Both these species may cause disseminated infection, which is associated with high mortality. We present a dramatic bronchoscopic image of P. boydii endobronchial infection after lung transplantation in a patient with underlying cystic fibrosis. P. boydii should be in the differential diagnosis of endobronchial infections in patients with cystic fibrosis receiving lung transplantation.