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Pulmonary Aspergillus sydowii Infection in a Patient with Pulmonary Hyalinizing Clear Cell Carcinoma: A Rare Case Report and Review of Reported Cases

Year: 2026

Type: article

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. Keywords: Aspergillus sydowii , pulmonary aspergillosis, hyalinizing clear cell carcinoma, voriconazole, therapeutic drug monitoring

Source: Infection and Drug Resistance

DOI: 10.2147/idr.s649592

Authors: Weixing Wu, Qun Wang, Yanyu Xiao, Li Zhang

Institutions: Chinese Academy of Medical Sciences & Peking Union Medical College, Southern University of Science and Technology, Shenzhen Third People’s Hospital

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836