S17 

Pulmonary Phaehyphomycosis in Retroviral Disease Patient 
 

Ummu Afeera Binti Zainulabid1, Muhammad Naimmuddin Bin Abdul Azih1, Sasi Kumar A/L 

Maniyam1, Azliana Binti Abd. Fuaa2, Mohd Radhwan bin Abidin3, Hajar Fauzan Bin Ahmad4 

 

 

Abstract 

 

Pulmonary phaeohyphomycosis is a rare infection in the lung caused by black fungi containing 

a cytoplasmic melanin-like pigment. A 42-year-old man with underlying retroviral disease on 

HAART was investigated for having constitutional symptoms. Despite undetectable viral load 

and a high CD4 count, he was found to have unexplained significant loss of weight and appetite 

over a period of 6 months. Clinical examination revealed a cachexic man with multiple inguinal 

lymphadenopathies. Excisional biopsy of the inguinal lymph node revealed reactive follicular 

hyperplasia. CT Thorax, Abdomen and Pelvis was arranged to look for occult malignancy or 

infection and he was found to have multiple non-enhancing subcentimeter lung nodules mainly 

at the lateral segment of the right middle lobe of his lung. The largest nodule measured about 

0.8 x 1.5 x 0.5 (AP x W x CC), with some nodules having an irregular margin with no extension 

into the adjacent bronchi. Bronchoscopy was done and demonstrated a black patch at the right 

intermedius, lateral segment of the middle lobe which did not disappear upon bronchial flush 

or wash. Histopathological examination found focal areas of blackish pigment and the 

bronchial alveolar lavage sent for fungal culture grew Cladosporium species. The patient was 

treated with oral Itraconazole with marked clinical improvement. This case highlights an 

unusual black fungi infection in the lung that stands out not only for its rarity and it's 

responsiveness to treatment, but also the susceptibility of an RVD positive patient to this 

infection despite having suppressed viral load and normal CD4 count. 

Keywords: Kounis Syndrome, acute coronary syndrome, anaphylactoid reaction, mast cell 

activation 

 

1. Internal medicine, Hospital Tuanku Ampuan Najihah, Malaysia 

2. Department of Pathology and Laboratory Medicine, Kulliyyah of Medicine, International Islamic 

University of Malaysia 

3. Department of Radiology, Kulliyyah of Medicine, International Islamic University of Malaysia 

4. Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang 

  

DOI: http://dx.doi.org/10.31344/ijhhs.v5i0-2.335  
 

http://dx.doi.org/10.31344/ijhhs.v5i0-2.335