Disseminated infection due to Chrysosporium zonatum in a patient with chronic granulomatous disease and review of non-Aspergillus fungal infections in patients with this disease

We report the first case of Chrysosporium zonatum infection in a 15-year-oI d male with chronic granulomatous disease who developed a lobar pneumonia a nd tibia osteomyelitis while on prophylaxis with gamma interferon. The fung us was isolated from sputum and affected bone, and hyphae were observed in the bone by histopathology, Therapy with amphotericin B eradicated the oste omyelitis and pneumonia, but pneumonia recurred in association with pericar ditis and pleuritis during therapy with itraconazole. These manifestations subsided, and no recurrences occurred,vith liposomal amphotericin B therapy . Infections caused by Chrysosporium species are very rare, and C. zonatum has not previously been reported to cause mycosis in humans. This species, the anamorph of the heterothallic ascomycete Uncinocarpus orissi (family On ygenaceae), is distinguished by its thermotolerance, by colonies which dark en from yellowish white to buff, and by club-shaped terminal aleurio-conidi a borne at the ends of short, typically curved stalks. The case isolate pro duced fertile ascomata in mating tests with representative isolates. The me dian (range) MICs for our isolate as well as those for two other human isol ates and a nonhuman isolate determined by the National Committee for Clinic al Laboratory Standards method adapted for moulds were less than or equal t o 0.06 mu g/ml (less than or equal to 0.06 to 0.25 mu g/ml) for amphoterici n B, 0.687 mu g/ml (0.25 to 2 mu g/ml) for itraconazole, >128 mu g/ml (>128 mu g/ml) for flucytosine, and 48 mu g/ml (32 to >128 mu g/ml) for fluconaz ole.