Rad-12. Nodular Dactylaria pneumonia.

A 48-year-old African American male presented with a mild nonproductive cough. He was afebrile and clinical exam was unremarkable. Significant past medical history consisted of a cadaveric renal transplant in 1992, which subsequently underwent chronic rejection requiring transplant nephrectomy 5 years later. He was maintained on hemodialysis and received a second cadaveric transplant in October 2000. Two years later the patient developed hemoptysis with persistent cough and a chest radiograph revealed multiple nodular opacities in both lungs. Subsequent CT demonstrated multiple focal nodules with associated confluent airspace consolidation. Bronchial alveolar lavage fluid grew Dactylaria gallopava. D gallopava is a dematiaceous, nematophagic fungus found in the soil in the Southeastern United States. Since the first case in 1986 only 9 documented cases of human infection with D gallopava have been reported, 3 of which have been in the state of South Carolina. In all reported cases, the host was immunocompromised, usually due to transplant. To our knowledge, this is the first reported case of widespread pulmonary nodular masses due to D gallopava in a renal transplant patient. In this case report we describe the radiographic differential diagnosis, clinical implications, and treatment options for a newly emerging pathogen, D gallopavum, in the immunocompromised patient.

Damon A. Black, MD, and Stephen I. Schabel, MD. Medical University of South Carolina, Charleston, SC.