Infections caused by the Scedosporium genus have become recognized as a fatal complication after
lung transplantation in Europe and Australia, but the reports have been rare from Asian countries including Japan. We present a case of
pneumonia caused by a
mixed infection of Scedosporium apiospermum (SA) and Lomentospora prolificans (LP) that developed after augmentation of immunosuppression for chronic lung allograft dysfunction (CLAD) after
lung transplantation. A 13-year-old man underwent bilateral
lung transplantation for
pulmonary hypertension. One year after surgery, he was treated with a series of augmented immunosuppressive therapy for severe acute rejection and subsequent CLAD. Three months following the first
steroid pulse
therapy, his serum β-
D-glucan elevated without any sign of
fungal infection by other tests. The serum β-
D-glucan once returned to a normal level by empirical administration of
micafungin; however, the patient's condition worsened again by discontinuation of it. He did not recover by restarting
micafungin, and computed tomography (CT) scans eventually demonstrated new infiltrates in his lung field 6 weeks after the elevation of serum β-
D-glucan. Microscopic findings of transbronchial lung biopsy specimens showed filamentous fungi, and the culture of bronchoalveolar lavage fluid revealed the growth of SA and LP. Despite subsequent
voriconazole administration, he died 14 days after the start of
voriconazole. Early and aggressive inspection including bronchoscopy should be performed for the diagnosis of
Scedosporium infection in immunocompromised patients, even if CT scans and sputum culture show no evidence of
infection.