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Disseminated Geosmithia argillacea infection in a patient with gastrointestinal GvHD

Bone Marrow Transplantation volume 47, pages 734–736 (2012)Cite this article

Fungal infections remain a major complication after haematopoietic SCT. Patients with GvHD are especially at risk for pulmonary fungal infections.1 Prophylactic regimens for patients with GvHD include posaconazole2 and voriconazole,3 and have demonstrated ability to prevent invasive fungal infections in a majority of patients undergoing allo-SCT for haematological malignancies. However, zygomycetes, Fusarium spp., and other rare moulds may cause major problems due to their resistance to these commonly used antifungal agents.

After 7 days of caspofungin and liposomal amphotericin B, the C-reactive protein decreased significantly and a follow-up computed tomography scan revealed the occurrence of a second lesion, whereas the halo sign of the primary infiltrate had resolved (Figure 1b). However, later in the course, the patient deteriorated and the C-reactive protein increased again. Aside from adaptations of the empiric antibacterial treatment, i.v. itraconazole 200 mg twice daily was added. Despite triple antifungal therapy, the patient ultimately died shortly thereafter due to multiple organ failure as a consequence of refractory acute GvHD with subsequent fungal infection. Swabs from lung and central nervous system obtained during autopsy (Figure 1c) grew many colonies of G. argillacea, indicating that the mould was still viable after more than 2 weeks of antifungal combination treatment. Histology from the central nervous system revealed massive infiltration by G. argillacea (Figure 2c).

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Authors and Affiliations

  1. Division of Pulmonology, Department of Internal Medicine, Section of Infectious Diseases, Medical University of Graz, Graz, Austria

    T Valentin, I Zollner-Schwetz, M Hoenigl, H J F Salzer & R Krause

  2. Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria

    P Neumeister, M Pichler & A Rohn

  3. Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria

    C Koidl, D Haas, B Heiling & W Buzina

  4. Institute of Pathology, Medical University of Graz, Graz, Austria

    M Asslaber

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  1. T Valentin
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Correspondence to T Valentin.

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Valentin, T., Neumeister, P., Pichler, M. et al. Disseminated Geosmithia argillacea infection in a patient with gastrointestinal GvHD. Bone Marrow Transplant 47, 734–736 (2012). https://doi.org/10.1038/bmt.2011.149

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