Pleuritis caused by Acremonium strictum in a patient with metastatic testicular teratocarcinoma

A 23-year-old boy was hospitalized for dyspnea with mild fever. Chest x-ray documented left pleural effusion. Cultures from thoracentesis grew out Acremonium strictum and intravenous liposomal amphotericin B was given at a dose of 200 mg daily. On treatment, fever subsided but dyspnea worsened. Whole-body CT scan was arranged showing multiple bilateral lung nodules, systemic lymphadenopathies and a mass over the left testis. Biopsies from an enlarged sovraclavear lymph node revealed metastatic testicular teratocarcinoma. Chemotherapy with PEB was started but, at day 70 from admission, the patient died of acute respirature distress syndrome.