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She had been diagnosed with bronchiectasis about 30 years earlier and was doing well until 7 years Pfizer Licensed Compound Library concentration prior to presentation when she was diagnosed with pulmonary Mycobacterium avium complex infection. She was treated with clarithromycin, rifampin, and ethambutol for over 2 years with improvement in symptoms. Over the next few years, dyspnea on exertion and mucus production slowly increased. During the 5 years prior to presentation, 12 respiratory cultures for acid-fast bacilli were performed, and all were negative. Seven fungal respiratory cultures were performed during this time as well, and all returned positive for Exophiala jeanselmei, which was thought to represent colonization. These isolates were identified based on morphology, which is known to be unreliable [14]. In the 3 months before presentation, dyspnea on exertion and cough Temsirolimus (CCI-779, NSC 683864) significantly worsened, and the patient began to produce black sputum (Figure 1). Physical examination was unremarkable. A thoracic CT scan revealed bronchiectasis that was unchanged and new consolidations in the lower lobes. Sputum acid-fast culture was negative. Sputum fungal culture grew a black, yeast-like mold (Figure 2), which was again identified on the basis of morphological characteristics as Exophiala jeanselmei. Susceptibility testing demonstrated an MIC of 0.5?��g/mL for amphotericin B, 0.5?��g/mL for itraconazole, and 0.25?��g/mL for voriconazole. The patient was started on 200?mg of itraconazole daily. After 6 weeks of therapy, the patient was no longer producing black sputum and began to have some improvement in her symptoms. By 5 months of therapy, the patient had experienced a dramatic improvement in symptoms. Therapy was continued for a total of 6 months. Figure 1 Figure 2 Three weeks after stopping itraconazole the patient again developed increased shortness of breath and cough productive of black sputum. Sputum fungal culture at that time grew an isolate morphologically identified as Exophiala dermatitidis. DNA sequencing of the ITS and D1/D2 regions confirmed the specimen to be Exophiala dermatitidis. Susceptibility http://www.selleckchem.com/products/pifithrin-alpha.html testing revealed an MIC of 1?��g/mL for amphotericin B, 0.5?��g/mL for itraconazole, 0.25?��g/mL for posaconazole,