Ciliocytophthoria, A Faux Pas in the way of Diagnosis of Lophomonas Infection

Abstract

Rationale: In this study, we discuss a case of ciliocytophthoria, an artefact commonly confused in the microscopy of bronchoalveolar lavage fluid for Lophomonas blattarum, which causes a significant diagnostic error.

Patient Concern: A 45-year-old man was admitted in the ICU with symptoms of difficulty in breathing. He was previously admitted in the hospital with COVID pneumonia. His Chest X-ray showed the features of consolidation, and was not responding to broad spectrum antibiotics. With a suspicion of atypical pathogen, the BAL sample was sent. Microscopy revealed motile structures, which were initially confused as a protozoan parasite Lophomonas blattarum. The sputum culture grew mucoid strain of multidrug resistant Pseudomonas aeruginosa, which was treated with tetracycline. 

Intervention: The patient was treated with tetracycline 500mg for 5 days and he showed a drastic improvement. Due to lack of resources for molecular test, we sent the video to CDC diagnostic assistance team. It was confirmed as ciliocytophthoria 

Outcome: Patient was improved upon therapy

Lesson: Lophomonas blattarum rarely causes disease in humans. Hence, ciliocytophthoria should always be considered as an important differential diagnosis when suspecting of a protozoan parasitic infection in the respiratory tract.