Pulmonary hemorrhage in an infant following 2 weeks of fungal exposure

Background: Exposure to indoor fungus growth and tobacco smoke has been epi demiologically linked to unexplained pulmonary hemorrhage in infants. Objective: To describe the 40-day-old male infant who had been exposed to f ungi for a discrete 2-week period followed by acute exposure to environment al tobacco smoke prior to development of a life-threatening pulmonary hemor rhage. Patient and Methods: History and clinical evaluation of the infant immediat ely followed the pulmonary hemorrhage. Air and surface sampling for isolati on and identification of fungal growth in the dwelling where the infant res ided before the acute hemorrhage was accomplished when the homeowner return ed from vacation 4 months after the clinical event. Results: Two fungi associated with mycotoxin production were cultured from surface samples collected in the residence: Penicillium (possibly Penicilli um purpurogenum) and a Trichoderma species. Stachybotrys atra was not isola ted from air or surface samples. Environmental tobacco smoke exposure occur red over a discrete several-hour period prior to onset of the acute pulmona ry hemorrhage. Conclusions: Avoidance of unnecessary exposure of infants to fungus growth in water-damaged environments or exposure to tobacco smoke is prudent. Furt her investigation into the toxic effects of indoor fungi as causes of infan tile pulmonary hemorrhage is warranted.