Pulmonary Scedosporiosis in Non-Immunocompromised Hosts: A Case Series and Literature Review

Background: Pulmonary scedosporiosis can occur without recognized immunosuppression, particularly in patients with structural lung disease. We characterized its clinical features, diagnostic approaches, treatment, and outcomes. Methods: We retrospectively analyzed 10 patients with Scedosporium detected in respiratory specimens during 2023–2025, and conducted a narrative review of 37 published adult cases with non-immunocompromised status. Findings: Among the 10 institutional patients, chronic structural or airway disease was present in 8/10, most commonly bronchiectasis (6/10). Cough (8/10) and sputum production (7/10) were common institutionally; hemoptysis occurred in 3/10 institutional patients and 27/37 published cases. Patchy opacities occurred in 7/10 and bronchiectasis occurred in 6/10 institutional patients, whereas cavities (20/37) and fungal balls (17/37) were common in published cases. Bronchoalveolar lavage fluid (BALF)-tNGS detected Scedosporium in all 10 institutional patients, whereas BALF culture was positive in 8/10. Species-level identifications were concordant in all eight culture-positive cases. All 37 published cases were culture-confirmed, with NGS additionally used in 3/37. The median interval from symptom onset to first detection was 17 days (IQR, 7–32.5) in the institutional cohort; among the 30/37 published cases with available data, the median interval from symptom onset to diagnosis was 5 months. All institutional patients initially received voriconazole. Eight of the 10 institutional patients were clinically diagnosed with infection, whereas two had insufficient evidence to distinguish infection from colonization. Three institutional patients were cured, five improved, and two were lost to follow-up after 3–5 days. Among the published cases, 29/37 were cured or improved, 3/37 died, and 5/37 were lost to follow-up. Interpretation: Pulmonary scedosporiosis should be considered in patients with structural lung disease and persistent or progressive pulmonary lesions. Diagnosis should integrate clinical, radiological, bronchoscopic, and microbiological findings. tNGS may complement fungal culture. Voriconazole remains first-line treatment, and surgery may be considered in patients with localized progressive cavitary disease or hemoptysis.