Bronchial Artery-Pulmonary Artery Shunt by <i>Apiotrichum mycotoxinivorans</i> Infection in a Recurrent Hemoptysis Case

Background Apiotrichum mycotoxinivorans is a rare mycotoxinivorans, and its pathogenicity is unknown. Bronchial artery shunt is a pathophysiological state following congenital or acquired chronic infection. We report a rare case of bronchial artery shunt by A. mycotoxinivorans infection in a recurrent hemoptysis patient. Case presentation A 45-year-old female presented with recurrent cough and hemoptysis for 4 years. Before admission, she had been treated in several hospitals for pulmonary tuberculosis and bronchiectasis and received standardized anti-tuberculosis treatment for 1 year, but it was ineffective. After admission, CTPA and bronchial arterial angiography showed left bronchial artery-left pulmonary artery shunt and right bronchial artery-right pulmonary artery shunt. Fiber-optic bronchoscopy was performed, which revealed a large amount of purulent secretions, bronchoalveolar lavage fluid fungi (1-3)-β-d glucan: 728.06, and GM test: 3.239. Fungal hyphae and spores were observed by gram staining of BALF smear. Acid-fast bacilli were not found in BALF smear and brush smear. Two consecutive BALF fungal cultures grew A. mycotoxinivorans , the identity of which was confirmed by internal-transcribed-spacer (ITS) sequencing. Intravenous amphotericin B liposome (30mg; 0.5mg/kg, QD) was given for 2 weeks, embolization was performed, and itraconazole (voriconazole allergy) was taken orally for 9 months after operation. Hemoptysis and pulmonary lesions gradually improved after treatment. Conclusion We report the first case of bronchial artery-pulmonary artery shunt in a patient diagnosed with A. mycotoxinivorans infection. Phagocytosis of fungi by leukocytes was observed, and the pathogenicity of the fungus was confirmed in order to heighten the awareness of these infections.