Allergic bronchopulmonary disease caused by Curvularia lunata and Drechslera hawaiiensis.

Abstract

Three patients who developed bronchoceles caused by fungi are described. The 1st patient presented for investigation of a lesion at the right hilum on chest radiograph and a raised eosinophil count. A bronchogram showed complete block of the apical segmental bronchus which at operation was shown to be caused by inspissated material. The 2nd patient was investigated because of a cough productive of plugs of sputum and irregular opacities in both upper zones on chest radiograph and a raised blood eosinophil count. This cleared after 1 mo. on high dose oral prednisone therapy. The 3rd patient with a previous history of left lingular pneumonia and bronchiectasis of the lingular segment of the left upper lobe was investigated 3 yr later for right basal shadowing and a raised blood eosinophil count. The radiograph cleared after 1 mo. on high dose oral prednisone treatment. The etiological agents in these cases were dematiaceous hyphomycetes, fungi ubiquitous in nature and agents of plant disease. The causal fungi, C. lunata and D. hawaiiensis, on a few occasions are reported to cause human disease, but in cases quite dissimilar to the 3 reported. Septate branching dematiaceous mycelium was consistently seen in the clinical material and isolated from successive sputum specimens from each patient. Immunodiffusion tests from the 3rd patient gave positive results for both fungi. I.p. inoculations of C. lunata and D. hawaiiensis into Swiss white mice proved the pathogenicity of these isolates.