Fusariosis in a Patient with Acute Myeloid Leukemia: A Case Report and Review of the Literature

• Published in: Mycopathologia (1975) 2016-06, Vol.181 (5-6), p.457-463
• Main Authors: Delia, Mario, Monno, Rosa, Giannelli, Giorgia, Ianora, Amato Antonio Stabile, Dalfino, Lidia, Pastore, Domenico, Capolongo, Carmen, Calia, Carla, Tortorano, Annamaria, Specchia, Giorgina
• Format: Article
• Language: English
• Subjects: Acute myelocytic leukemia; Adult; Amphotericin B; Amphotericin B - pharmacology; Amphotericin B - therapeutic use; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Antiparasitic agents; Biomedical and Life Sciences; Blood - microbiology; Development and progression; Eukaryotic Microbiology; Fatal Outcome; Fusariosis - diagnosis; Fusariosis - drug therapy; Fusariosis - microbiology; Fusariosis - pathology; Fusarium - drug effects; Fusarium - isolation & purification; Fusarium solani; Health aspects; Humans; Infection; Leukemia, Myeloid, Acute - complications; Life Sciences; Lung - diagnostic imaging; Lung - pathology; Male; Medical Microbiology; Microbial Ecology; Microbial Sensitivity Tests; Microbiological Techniques; Microbiology; Mycoses; Plant Sciences; Radiography, Thoracic; Skin; Skin - microbiology; Tomography, X-Ray Computed; Triazoles - pharmacology; Triazoles - therapeutic use
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-016-9987-5

Fusarium spp. causes infections mostly in patients with prolonged neutropenia. We describe the case of a disseminated Fusarium solani infection in a patient with acute myeloid leukemia which never reached complete remission during its clinical course. The patient had profound neutropenia and developed skin nodules and pneumonia in spite of posaconazole prophylaxis. F. solani was isolated from blood and skin biopsy, being identified from its morphology and by molecular methods. By broth dilution method, the strain was resistant to azoles, including voriconazole and posaconazole, and to echinocandins. MIC to amphotericin B was 4 mg/L. The patient initially seemed to benefit from therapy with voriconazole and amphotericin B, but, neutropenia perduring, his clinical condition deteriorated with fatal outcome. All efforts should be made to determine the correct diagnosis as soon as possible in a neutropenic patient and to treat this infection in a timely way, assuming pathogen susceptibility while tests of antimicrobial susceptibility are pending. A review of the most recent literature on invasive fungal infections is reported.