Aiping Zhang,* Zijian Wang,* Haoyu Sheng, Jianghua Yang

Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241001, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jianghua Yang, Department of Infectious Diseases, Yijishan Hospital of Wannan Medical College, Zheshan West Road, Jinghu District, Wuhu, Anhui, 241001, People’s Republic of China, Tel/Fax +86-553-5739406, Email yjhpath@163.com

Abstract: Scedosporium apiospermum (S. apiospermum) can cause fungal infections in near-drowning victims, and an increasing number of cases have been reported. However, cases of bone and joint infections caused by S. apiospermum are rare. In this case, a 35-year-old otherwise healthy Chinese female presented with aspiration pneumonia and knee arthritis after accidentally falling into sewage and near-drowning and underwent macrogenomic second-generation sequencing of arthrocentesis fluid, which showed S. apiospermum. However, new lesions involving the hip joint and spine continued to develop under voriconazole monotherapy. The patient was treated with voriconazole combined with amphotericin B cholesterol sulfate lipid complex for 30 consecutive days. The patient’s symptoms improved significantly. This case highlights the robust invasiveness of S. apiospermum and the extensive spread of infection, underscoring the importance of prompt diagnosis and treatment. A combined therapeutic approach may offer a safe and efficacious option for managing S. apiospermum infection.

Keywords: near-drowning, Scedosporium apiospermum, voriconazole, amphotericin B cholesterol sulfate lipid complex, metagenomic next-generation sequencing