Abdul Azih, Muhammad Naimmuddin and Wan Ramli, Wan Nurliyana and Zakaria, Nurul Aulia (2026) Purpureocillium lilacinum pneumonia in myositis-associated interstitial lung disease: successful treatment with oral itraconazole. Cureus Journal of Medical Science, 18 (7). pp. 1-6. ISSN 2168-8184
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Abstract
Purpureocillium lilacinum (P. lilacinum) is a rare opportunistic mold that predominantly affects immunocompromised hosts and exhibits intrinsic resistance to several conventional antifungal agents. Pulmonary infection is uncommon, and only a limited number of cases have been reported in patients with autoimmune connective tissue diseases receiving immunosuppressive therapy. We report a 37-year-old male hospital social worker with anti-Jo-1-positive myositis-associated interstitial lung disease receiving corticosteroids and mycophenolate mofetil who presented with hemoptysis and dyspnea. Computed tomography of the thorax demonstrated bilateral ground-glass opacities, multilobar consolidation, tree-in- bud nodularity, and mediastinal lymphadenopathy. Bronchoalveolar lavage fungal culture yielded P. lilacinum, with species identification confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Because second-generation triazoles were unavailable at the time of diagnosis, treatment was initiated with oral itraconazole (200 mg twice daily) together with temporary cessation of immunosuppressive therapy. The patient experienced rapid clinical improvement, with resolution of the acute pulmonary infiltrates on follow-up computed tomography after three months and a negative follow-up sputum fungal culture after six months of therapy. Immunosuppressive treatment was subsequently reintroduced without recurrence of infection or progression of interstitial lung disease during follow-up. This case highlights the diagnostic challenge of probable pulmonary P. lilacinum infection in immunosuppressed patients with myositis-associated interstitial lung disease. It demonstrates a favorable clinical course during prolonged oral itraconazole therapy when preferred antifungal agents were unavailable. However, treatment outcomes should be interpreted with caution, as this is a single case, and concomitant antibacterial therapy, along with temporary modification of immunosuppressive therapy, may also have contributed to recovery.
| Item Type: | Article (Case Report) |
|---|---|
| Uncontrolled Keywords: | anti-jo1 antibody, ground-glass opacities, hyalohyphomycosis, itraconazole, mofetil mycophenolate, myositis-related interstitial lung disease, purpureocillium lilacinum pneumonia |
| Subjects: | R Medicine > RC Internal medicine > RC582 Specialities of Internal Medicine- Immunologic Diseases R Medicine > RC Internal medicine > RC731 Specialties of Internal Medicine-Diseases of The Respiratory System |
| Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): | Kulliyyah of Medicine Kulliyyah of Medicine > Department of Internal Medicine |
| Depositing User: | Dr Nurul Aulia Zakaria |
| Date Deposited: | 06 Aug 2026 15:46 |
| Last Update: | 06 Aug 2026 15:46 |
| Queue Number: | 2026-07-Q4487 |
| URI: | http://irep.iium.edu.my/id/eprint/130478 |
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