Disseminated Fusarium infection originating from paronychia in a neutropenic patient: a case report and review of the literature

Abstract

Fusarium is a saprophytic organism that is widely found distributed in soil, subterranean and aerial plants, plant debris, and other organic substrates. It can cause local tissue infections in immunocompetent patients, such as onychomycosis, bone and joint infections, or sinusitis. The incidence of disseminated disease has notably increased since the initial cases of disseminated Fusarium were described, particularly affecting immunocompromised patients with hematologic malignancies. We report a 39-year-old man hospitalized with newly diagnosed acute myelocytic leukemia who developed disseminated Fusarium infection originating from toenail paronychia in the setting of neutropenia. Pathologic diagnosis of Fusarium is difficult because the septate hyphae of Fusarium are difficult to distinguish from Aspergillus, which has a more favorable outcome. Cultures of potential sources of infection as well as tissue cultures are essential in identifying the organism and initiating early aggressive therapy.

Figure 1

Erythematous, firm nodule on right shoulder. Similar lesions were also found on the right forearm, scalp and abdomen. The lesions developed central necrosis after four days.

Figure 2

The right great toenail had purulent drainage with surrounding edema and erythema that tracked up the dorsal foot.

Figure 3

Periodic acid-Schiff stain shows septate hyphae and reproductive structures suggestive of chlamydospores in the reticular dermis associated with dermal blood vessels. (PAS, original magnification x )