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Background   Schizophyllum commune  is a basidiomycete that lives in the environment and can cause infections, mainly those of the respiratory system. Although  S. commune  is increasingly reported as a cause of allergic bronchopulmonary mycosis and sinusitis, cases of fungal ball formation are extremely uncommon. Identification of  S. commune  is difficult using routine mycological diagnostic methods, and in clinically suspicious cases, internal transcribed spacer sequencing should be used for diagnosis. Here, we report a first case of lung cancer with a fungal ball formation of  S. commune , confirmed by analyzing the internal transcribed spacer.    Case presentation  A 76-year-old man with diabetes and hypertension was admitted to the hospital with a chief complaint of hemosputum, which he had for about 19 months. A computed tomography image of the patient’s chest showed a cavity and internal nodule in the left upper lobe of his lung. A left upper lobectomy was performed, and histopathological examination revealed squamous cell carcinoma of the lung and a fungal ball. The isolate from the surgical specimen was identified as  S. commune  by analyzing the internal transcribed spacer. The patient had no recurrence of the infection during 5 months of follow-up.    Conclusions  Only three cases of lung fungal balls caused by  S. commune  have been previously reported, and this is the first case of lung cancer cavity with a fungal ball formation. In cases of fungal ball formation in the lung,  S. commune  should be considered a possible causative microorganism.

A Schizophyllum commune fungus ball in a lung cancer cavity: a case report