Exophiala pneumonia requiring pneumonectomy in a post-renal transplant patient

Exophiala is a rare fungus that can cause fatal infections in patients who are immunocompromised. This case describes a 55-year-old post-renal transplant patient undergoing active treatment for multiple myeloma who presented to the emergency room with complaints of cough and dyspnea. She was found to have a cavitary lesion in the left upper lobe of her lung, and direct sampling via bronchoscopy revealed an invasive fungal infection with an Exophiala species. Despite initial improvement on antifungal therapy, her clinical course deteriorated requiring pneumonectomy and formation of brain abscess. This case emphasizes the challenge of invasive fungal infections and the importance of broad differentials in patients who are immunocompromised.