A Rare Case of Malbranchea Species Pulmonary Infection in the Setting of Suspected Selective Immunoglobulin M Deficiency

Humoral immunodeficiencies are traditionally associated with prolonged and recurrent respiratory tract infections, including unusual pathogens. We describe a case of a 63-year-old man with a history of chronic obstructive pulmonary disease and recurrent pneumonias (including Pseudomonas) who presented with cough, dyspnea, and respiratory failure with computed tomography imaging showing bilateral consolidations and cavitary lesions. The bronchoalveolar lavage fungal culture grew Malbranchea species, whereas viral, bacterial, and mycobacterial cultures were negative. Because of multiple hospitalizations for pneumonia and the presence of this unusual pathogen, quantitative immunoglobulin levels were obtained, revealing an undetectable total immunoglobulin M (IgM) level (

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