Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 152 No. 4950 (2022)

Atypical pulmonary phaeohyphomycosis due to Aureobasidium spp. – case report and brief literature review

  • Davide Bosetti
  • David Spoerl
  • Arnaud Riat
  • Claudio De Vito
  • Stavroula Masouridi-Levrat
  • Yves Chalandon
  • Dionysios Neofytos
Cite this as:
Swiss Med Wkly. 2022;152:40011


We report on a case of probable invasive Auerobasidium spp. pulmonary infection in a patient with myelodysplastic syndrome. The patient was successfully treated with liposomal amphotericin B monotherapy, with transition to orally administered isavuconazole. This case shows an atypical initial radiological presentation with diffuse ground-glass opacities, as previously demonstrated in cases of Aureobasidium spp. hypersensitivity pneumonitis. Moreover this case further highlights the difficulties associated with the diagnosis and complexity in the management of Aureobasidium spp. infections.


  1. Roth RS, Masouridi-Levrat S, Chalandon Y, Mamez AC, Giannotti F, Riat A, et al. Invasive Mold Infections in Allogeneic Hematopoietic Cell Transplant Recipients in 2020: Have We Made Enough Progress? Open Forum Infect Dis. 2021 Nov;9(1):ofab596. 34993259 2328-8957 DOI:
  2. Hoenigl M, Salmanton-García J, Walsh TJ, Nucci M, Neoh CF, Jenks JD, et al. Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology. Lancet Infect Dis. 2021 Aug;21(8):e246–57. 33606997 1474-4457
  3. Wang SC, Lo HJ, Lin LJ, Chen CH. Port catheter-associated Aureobasidium melanigenum fungemia. J Formos Med Assoc. 2018 Apr;117(4):346–7. 28676238 0929-6646 DOI:
  4. Chowdhary A, Perfect J, de Hoog GS. Black Molds and Melanized Yeasts Pathogenic to Humans. Cold Spring Harb Perspect Med. 2014 Nov;5(8):a019570. 25384772 2157-1422 DOI:
  5. Zalar P, Gostincar C, de Hoog GS, Ursic V, Sudhadham M, Gunde-Cimerman N. Redefinition of Aureobasidium pullulans and its varieties. Stud Mycol. 2008;61:21–38. 19287524 0166-0616 DOI:
  6. Revankar SG, Patterson JE, Sutton DA, Pullen R, Rinaldi MG. Disseminated phaeohyphomycosis: review of an emerging mycosis. Clin Infect Dis. 2002 Feb;34(4):467–76. 11797173 1537-6591 DOI:
  7. Kutleša M, Mlinarić-Missoni E, Hatvani L, Voncina D, Simon S, Lepur D, et al. Chronic fungal meningitis caused by Aureobasidium proteae. Diagn Microbiol Infect Dis. 2012 Jul;73(3):271–2. 22504065 1879-0070 DOI:
  8. Wang M, Danesi P, James TY, Al-Hatmi AM, Najafzadeh MJ, Dolatabadi S, et al. Comparative pathogenicity of opportunistic black yeasts in Aureobasidium. Mycoses. 2019 Sep;62(9):803–11.31107996 1439-0507 DOI:
  9. Wei X, Liu GL, Jia SL, Chi Z, Hu Z, Chi ZM. Pullulan biosynthesis and its regulation in Aureobasidium spp. Carbohydr Polym. 2021 Jan;251:117076. 33142619 1879-1344 DOI:
  10. Maverick KJ, Conners MS. Aureobasidium pullulans fungal keratitis following LASEK. J Refract Surg. 2007 Sep;23(7):727–9. 17912946 1081-597X DOI:
  11. Huang YT, Liaw SJ, Liao CH, Yang JL, Lai DM, Lee YC, et al. Catheter-related septicemia due to Aureobasidium pullulans. Int J Infect Dis. 2008 Nov;12(6):e137–9. 18450495 1878-3511 DOI:
  12. Clark EC, Silver SM, Hollick GE, Rinaldi MG. Continuous ambulatory peritoneal dialysis complicated by Aureobasidium pullulans peritonitis. Am J Nephrol. 1995;15(4):353–5. 7573197 0250-8095 DOI:
  13. Hawkes M, Rennie R, Sand C, Vaudry W. Aureobasidium pullulans infection: fungemia in an infant and a review of human cases. Diagn Microbiol Infect Dis. 2005 Mar;51(3):209–13. 15766608 0732-8893 DOI:
  14. Mise N, Ono Y, Kurita N, Sai K, Nishi T, Tagawa H, et al. Aureobasidium pullulans peritonitis: case report and review of the literature. Perit Dial Int. 2008 Nov-Dec;28(6):679–81. 18981405 0896-8608 DOI:
  15. Girardi LS, Malowitz R, Tortora GT, Spitzer ED. Aureobasidium pullulans septicemia. Clin Infect Dis. 1993 Feb;16(2):338–9. 8443324 1058-4838 DOI:
  16. Arranz Sánchez DM, de la Calle MC, Martín-Díaz MA, Flores CR, González-Beato MJ, Pinto PH, et al. Subcutaneous mycosis produced by Aureobasidium pullulans in a renal transplant recipient. J Eur Acad Dermatol Venereol. 2006 Feb;20(2):229–30. 16441646 0926-9959 DOI:
  17. Joshi A, Singh R, Shah MS, Umesh S, Khattry N. Subcutaneous mycosis and fungemia by Aureobasidium pullulans: a rare pathogenic fungus in a post allogeneic BM transplant patient. Bone Marrow Transplant. 2010 Jan;45(1):203–4. 19483761 1476-5365 DOI:
  18. Kaczmarski EB, Liu Yin JA, Tooth JA, Love EM, Delamore IW. Systemic infection with Aureobasidium pullulans in a leukaemic patient. J Infect. 1986 Nov;13(3):289–91. 3466961 0163-4453 DOI:
  19. Krcméry V Jr, Spánik S, Danisovicová A, Jesenská Z, Blahová M. Aureobasidium mansoni meningitis in a leukemia patient successfully treated with amphotericin B. Chemotherapy. 1994 Jan-Feb;40(1):70–1. 8306819 0009-3157 DOI:
  20. Salkin IF, Martinez JA, Kemna ME. Opportunistic infection of the spleen caused by Aureobasidium pullulans. J Clin Microbiol. 1986 May;23(5):828–31. 3711270 0095-1137 DOI:
  21. Tan HP, Wahlstrom HE, Zamora JU, Hassanein T. Aureobasidium pneumonia in a post liver transplant recipient: a case report. Hepatogastroenterology. 1997 Jul-Aug;44(16):1215–8.9261629 0172-6390
  22. Kuster S, Stampf S, Gerber B, Baettig V, Weisser M, Gerull S, et al.; Swiss Transplant Cohort Study. Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: A Swiss transplant cohort study. Transpl Infect Dis. 2018 Dec;20(6):e12981. 30144374 1399-3062 DOI:
  23. Taylor PE, Esch R, Flagan RC, House J, Tran L, Glovsky MM. Identification and possible disease mechanisms of an under-recognized fungus, Aureobasidium pullulans. Int Arch Allergy Immunol. 2006;139(1):45–52. 16276113 1018-2438 DOI:
  24. Woodard ED, Friedlander B, Lesher RJ, Font W, Kinsey R, Hearne FT. Outbreak of hypersensitivity pneumonitis in an industrial setting. JAMA. 1988 Apr;259(13):1965–9. 3346977 0098-7484 DOI:
  25. Engelhart S, Rietschel E, Exner M, Lange L. Childhood hypersensitivity pneumonitis associated with fungal contamination of indoor hydroponics. Int J Hyg Environ Health. 2009 Jan;212(1):18–20. 18375180 1438-4639 DOI:
  26. Temprano J, Becker BA, Hutcheson PS, Knutsen AP, Dixit A, Slavin RG. Hypersensitivity pneumonitis secondary to residential exposure to Aureobasidium pullulans in 2 siblings. Ann Allergy Asthma Immunol. 2007 Dec;99(6):562–6. 18219839 1081-1206 DOI:
  27. Stark PC, Celedón JC, Chew GL, Ryan LM, Burge HA, Muilenberg ML, et al. Fungal levels in the home and allergic rhinitis by 5 years of age. Environ Health Perspect. 2005 Oct;113(10):1405–9. 16203255 0091-6765 DOI:
  28. Shoham S, Dominguez EA ; AST Infectious Diseases Community of Practice. Emerging fungal infections in solid organ transplant recipients: Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13525. 30859651 1399-0012 DOI:
  29. Prasongsuk S, Sullivan RF, Kuhirun M, Eveleigh DE, Punnapayak H. Thailand habitats as sources of pullulan-producing strains of Aureobasidium pullulans. World J Microbiol Biotechnol. 2005;21(4):393–8. 0959-3993 DOI:
  30. Chan GF, Puad MS, Chin CF, Rashid NA. Emergence of Aureobasidium pullulans as human fungal pathogen and molecular assay for future medical diagnosis. Folia Microbiol (Praha). 2011 Sep;56(5):459–67. 21909832 1874-9356 DOI:
  31. Hofman V, Butori C, Long E, Le Fichoux Y, Hofman P. Aureobasidium pullulans contamination in bronchial aspirates mimicking cryptococcosis: a rare diagnostic pitfall. Pathology. 2008 Dec;40(7):729–32. 18985533 0031-3025 DOI:
  32. Revankar SG. Therapy of infections caused by dematiaceous fungi. Expert Rev Anti Infect Ther. 2005 Aug;3(4):601–12. 16107199 1744-8336 DOI:
  33. Cuenca-Estrella M, Gomez-Lopez A, Mellado E, Buitrago MJ, Monzon A, Rodriguez-Tudela JL. Head-to-head comparison of the activities of currently available antifungal agents against 3,378 Spanish clinical isolates of yeasts and filamentous fungi. Antimicrob Agents Chemother. 2006 Mar;50(3):917–21. 16495251 0066-4804 DOI:
  34. Espinel-Ingroff A, Boyle K, Sheehan DJ. In vitro antifungal activities of voriconazole and reference agents as determined by NCCLS methods: review of the literature. Mycopathologia. 2001;150(3):101–15. 10.1023/A:1010954803886 11469757 0301-486X DOI:
  35. Espinel-Ingroff A. In vitro antifungal activities of anidulafungin and micafungin, licensed agents and the investigational triazole posaconazole as determined by NCCLS methods for 12,052 fungal isolates: review of the literature. Rev Iberoam Micol. 2003 Dec;20(4):121–36.15456349 1130-1406

Most read articles by the same author(s)