Scedosporium apiospermum Pneumonia in an Immunocompetent Host.

Invasive fungal infections are being increasingly identified recently. Scedosporium is a significant cause of non-Aspergillus mold infection. It can cause disseminated disease in an immunocompromised host and localized pulmonary infection in immunocompetent ones, especially in those with preformed lung cavities. We present a case of scedosporiosis in an elderly female with bronchiectasis who presented with refractory pulmonary symptoms and infiltrates. The case emphasizes the need to keep the fungal infection in the differential diagnosis of refractory infiltrates in immunocompetent individuals without preformed cavities if they have bronchiectasis. Voriconazole monotherapy can be used as the first-line in proven cases of scedosporiosis.

Concealed Malignancy as a Rare Cause of Refractory Lactic Acidosis: A Fatal Case.

Lactic acidosis is a state in which there is a buildup of lactate in the body to form an excessively low pH in the blood. Elevated lactate levels are often thought to be indicative of relative tissue hypoxia or type A lactic acidosis. Shock, severe anemia, and thromboembolic events can all cause elevated lactate due to tissue hypoperfusion. Malignancy can also lead to an elevation in lactate, a phenomenon described as type B lactic acidosis. Here, we report a case of a 66-year-old male with elevated lactate level, which was refractory to medical treatment. Despite adequate management, including continuous renal replacement therapy, the lactate continued to rise, and consequently, the patient died due to cardiac arrest. Type B lactic acidosis must be considered in patients with elevated lactate levels without hypotension as it has a high mortality rate.