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Introduction

Peniophora bicornis is a fungus belonging to the Peniophora genus [5]. Peniophora is one of the oldest corticoid fungi that cause white rot on trees and plants. More specifically, it typically grows on dead branches [6]. Despite being one of the oldest fungi, there is limited information about how the Peniophora genus can affect human health. This is the second known case of Peniophora infection in the human lung. In contrast to the first case, the patient denied environmental exposures. Despite having an infection from Peniophora bicornis, the patient’s lung function test with spirometry was normal, and she denied fever and other respiratory symptoms.

Case Presentation

A 62-year-old female with a history of non-obstructive coronary artery disease, primary hypertension, chronic obstructive pulmonary disease, pulmonary candidiasis, and a 26-pack-year smoking history reported to the cardiology clinic for a follow-up for chest pain and a pre-operative cardiovascular examination for an upcoming left hip surgery. At the time of the visit, she had no shortness of breath, dizziness, or fatigue. A CTA coronary scan was performed which revealed 2 small non-calcified nodules in the left lung at which point she was referred to us.

Upon examination, the patient denied shortness of breath, fatigue, chills, or fever. The patient was hemodynamically stable (Table 1) and pulmonary function tests were normal (Table 2). Her family history is notable for malignant neoplastic disease in her mother and unspecified lung diseases in her father and sister. The laboratory workup is shown below (Table 3).

A CT scan was performed which revealed calcified lymph nodes in the right hilar region and right paratracheal region with the largest measuring 13mm on short axis diameter. A bronchoalveolar lavage revealed a white mold in the right middle lobe of the lung. Lab sequencing was performed and the mold was identified as Peniophora bicornis.

Discussion

Peniophora bicornis is a plant fungus that causes white rot on trees [3]. Members of the Peniophora genus are located all over the world with high concentrations on the east coast of the United States of America and in Europe [3]. Some members of Peniophora have been known to produce astaxanthin, a xanthophyll carotenoid that has antioxidant properties [2]. Astaxanthin has been seen to have positive effects against inflammation, diabetes, cardiovascular disease, and anti-cancer properties but it is not clear if astaxanthin is produced by P. bicornis [2]. Peniophora is not commonly associated with infection in humans [4]. The first recorded case of a Peniophora lung infection was discovered in a farmer who had possible exposure to fungi and multiple comorbidities [4]. Our patient, though absent of any known exposure to fungi, was known to have pulmonary candidiasis, an infection commonly associated with a weakened immune system [1]. This along with her history of coronary artery disease, hypertension, COPD and a long-standing smoking history could have made her more susceptible to what could be an opportunistic fungal infection.

Conclusion

The Identification of Peniophora bicornis in human lung on bronchoalveolar lavage strengthens the need for dedicated fungal study including laboratory sequencing when the etiology is unclear. The literature regarding pathogenesis of Peniophora bicornis and its implication is scarce and we recommend further study into the diagnostic, clinical implication and treatment of Peniophora bicornis.