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Successful treatment of disseminated fusariosis

Bone Marrow Transplantation volume 31, pages 411–412 (2003)Cite this article

Disseminated Fusarium spp infections are associated with high mortality in immunocompromised patients. The persistent and profound neutropenia in severe forms of aplastic anemia (SAA) limits survival of these patients in the setting of invasive fungal infections. Therapeutic options are scarce and mortality reached 80% in the largest review of patients with SAA and disseminated fusariosis.1 We report the first case of a pediatric patient with SAA and disseminated fusariosis successfully treated with combination therapy including voriconazole and only the second patient with SAA to survive disseminated Fusarium infection. Furthermore, the patient underwent two CD34+ haplo-identical hematopoietic stem cell transplants (HSCT) without evidence of disease progression.

A 3-year-old female with SAA presented with cellulitis of the right knee after a fall. Wound cultures yielded Bacillus cereus and she received a 35-day course of meropenem. The ulcerated mass persisted after 1 month of therapy and a nonerythematous, soft tissue mass developed on the anterior medial left chest wall below a central venous catheter exit site. MRI of the knee demonstrated involvement of medial and lateral compartments with a small suprapatellar effusion and diffuse enhancement of the soft tissues. A chest and abdominal CT revealed a 4-cm anterior left chest wall mass and a 4-mm subcapsular hypodense splenic lesion. A punch biopsy of the knee demonstrated infiltration of the dermis by branching septate hyphae; cultures yielded Fusarium oxysporum. Susceptibility testing of the isolate performed at the University of Texas Health Science Center at San Antonio revealed an MIC for amphotericin B of 2 μg/ml and 4 μg/ml for voriconazole. Treatment with 12 mg/kg/day of a liposomal formulation of amphotericin B (Ambisome, Fujisawa USA, Deerfield, IL, USA) was begun. Owing to the historically poor outcomes of similar cases, compassionate use of voriconazole (Vfend, Pfizer, Groton, CO), 6 mg/kg loading dose followed by 4 mg/kg twice daily i.v. was added 4 days later, after approval by the Institutional Review Board and informed consent was obtained. We elected to use both agents since there is little experience with the use of voriconazole as single-agent therapy in this setting. In addition, granulocyte infusions and surgical debridement of the knee lesion and chest wall mass were performed. Branching septate hyphae morphologically consistent with Fusarium spp were present on microscopic examination and Fusarium was isolated from both sites. Persistent drainage from the knee and enlargement of the splenic lesion prompted repeat debridement of the knee, a CT-guided splenic biopsy and removal of the central venous catheter 2 weeks after the initial surgery, but thereafter the patient did well.

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Authors and Affiliations

  1. Department of Infectious Diseases, St. Jude Children's Research Hospital and University of Tennessee, Health Science Center, 332 N. Lauderdale, St Memphis, 38105, TN, USA

    C A Rodriguez, J Luján-Zilbermann, M Andreansky & E E Adderson

  2. Department of Hematology-Oncology, St. Jude Children's Research Hospital and University of Tennessee, Health Science Center, 332 N. Lauderdale, St Memphis, 38105, TN, USA

    M Andreansky

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  1. C A Rodriguez
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  2. J Luján-Zilbermann
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  3. P Woodard
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  4. M Andreansky
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Rodriguez, C., Luján-Zilbermann, J., Woodard, P. et al. Successful treatment of disseminated fusariosis. Bone Marrow Transplant 31, 411–412 (2003). https://doi.org/10.1038/sj.bmt.1703857

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