Invasive pulmonary infection due to Scedosporium apiospermum in two children with chronic granulomatous disease

Scedosporium apiospermum is an opportunistic fungus in humans. The incidenc e of S. apiospermum infection in patients with acquired neutropenia (e.g., patients receiving chemotherapy and bone marrow transplant recipients) is s teadily increasing. S. apiospermum has poor in vitro susceptibility to "con ventional" antifungal agents, rendering the management of infections comple x. Patients with chronic granulomatous disease (CGD) are highly susceptible to fungal infections, which are mostly due to Aspergillus species. We desc ribe two children with CGD and invasive pulmonary infection due to S. apios permum. Both patients were treated with antifungal therapy including azole derivatives (itraconazole or voriconazole) and surgical resection of infect ed tissues. These cases highlight that scedosporium infection can closely m imic aspergillus infection and should be considered in any case in which th ere is a failure to respond to appropriate "conventional" antifungal therap y. We also suggest that the emergence of this pathogen may have been favore d by long-term use of amphotericin B in both patients.