Pichia Guilliermondii Infection - A Rare Differential Diagnosis Of Pulmonary Nodules

A patient presented himself with pungent, breath-dependent right chest pain and dyspnea at rest in our emergency department. The physical examination and the ECG revealed no relevant findings. The laboratory results showed an increased CRP, leukocytosis, elevated D-dimers and a respiratory partial insufficiency. In the thoracic CT angiography unclear pulmonary nodules (PN) were seen. The bronchoscopy was macroscopically normal. In the BAL yeasts and a high proportion of immune senescence cells (CD57+) were identified. After a pulmonary wedge resection resulted histologically an epithelioid cell-granulomatous inflammation. Molecular pathological a mycelium genome, in particular Pichia guilliermondii (PC) was detected. The therapy with fluconazole was successful. PC rarely causes candidemia, increased in immunocompromised patients. In our judgement this is in Europe the first described case of PC-infection in a patient, which presented no predisposition to infection with opportunistic pathogens apart from type 2 diabetes. Conclusion: It should be thought of fungal infection by these pathogens group in case of unclear PN, especially in combination with possibly predisposing factors.