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Exophiala dermatitidis Revealing Cystic Fibrosis in Adult Patients with Chronic Pulmonary Disease

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Abstract

Cystic fibrosis (CF) is a genetic inherited disease due to mutations in the gene cystic fibrosis transmembrane conductance regulator (CFTR). Because of the huge diversity of CFTR mutations, the CF phenotypes are highly heterogeneous, varying from typical to mild form of CF, also called atypical CF. These atypical features are more frequently diagnosed at adolescence or adulthood, and among clinical signs and symptoms leading to suspect a mild form of CF, colonization or infection of the respiratory tract due to well-known CF pathogens should be a warning signal. Exophiala dermatitidis is a melanized dimorphic fungus commonly detected in respiratory specimens from CF patients, but only very rarely from respiratory specimens from non-CF patients. We described here two cases of chronic colonization of the airways by E. dermatitidis, with recurrent pneumonia and hemoptysis in one patient, which led clinicians to diagnose mild forms of CF in these elderly patients who were 68- and 87-year-old. These cases of late CF diagnosis suggest that airway colonization or respiratory infections due to E. dermatitidis in patients with bronchiectasis should led to search for a mild form of CF, regardless of the age and associated symptoms. On a broader level, in patients with chronic respiratory disease and recurrent pulmonary infections, an allergic bronchopulmonary mycosis or an airway colonization by CF-related fungi like E. dermatitidis or some Aspergillus, Scedosporium or Rasamsonia species, should be considered as potential markers of atypical CF and should led clinicians to conduct investigations for CF diagnosis.

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Authors and Affiliations

  1. Laboratory of Medical Biology, University Hospital, Boulevard Fleming, 25030, Besançon, France

    Frédéric Grenouillet

  2. Chrono-Environnement, UMR UBFC/CNRS 6249 aff. INRA, University of Bourgogne/Franche-Comté, Besançon, France

    Frédéric Grenouillet

  3. Host-Pathogen Interactions Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France

    Bernard Cimon, Yohann Le Govic & Jean-Philippe Bouchara

  4. Laboratory of Parasitology-Mycology, Angers University Hospital, Angers, France

    Bernard Cimon, Yohann Le Govic & Jean-Philippe Bouchara

  5. Pneumology Department, University Hospital, Besançon, France

    Heloise Pana-Katatali, Marie Gainet-Brun & Bénédicte Richaud-Thiriez

  6. Pneumology Department, Adult CF Care Unit, Angers University Hospital, Angers, France

    Christine Person

  7. Laboratory of Genetic, Angers University Hospital, Angers, France

    Marie-Claire Malinge

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  1. Frédéric Grenouillet
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Correspondence to Frédéric Grenouillet.

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JPB received funding from Astellas, Pfizer and MSD for some research projects and organization of the meetings from the ECMM/ISHAM working group Fungal respiratory infections in Cystic Fibrosis (Fri-CF). Others authors did not have any conflicts of interest to declare.

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Grenouillet, F., Cimon, B., Pana-Katatali, H. et al. Exophiala dermatitidis Revealing Cystic Fibrosis in Adult Patients with Chronic Pulmonary Disease. Mycopathologia 183, 71–79 (2018). https://doi.org/10.1007/s11046-017-0218-5

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