Breakthrough Hormographiella aspergillata infections arising in neutropenic patients treated empirically with caspofungin

Abstract

Hormographiella aspergillata, a filamentous basidiomycete, has rarely been involved in human infections. We describe 2 febrile neutropenic patients who developed a severe pulmonary infection due to H. aspergillata while receiving empirical caspofungin therapy for presumed fungal pneumonia. After introduction of liposomal amphotericin B, one patient, who had neutrophil recovery, presented a favorable outcome, while the other, who remained neutropenic throughout the course of infection, died. Resistant fungi, including basidiomycetes, may emerge during empirical treatment with caspofungin in febrile neutropenic patients. A rapid switch to any other potent antifungal should be rapidly considered in case of failure of caspofungin in this setting.

FIG. 1.

(A) H. aspergillata cultured from lung biopsy specimen (patient 2) after 2 weeks of incubation on Sabouraud agar. (B) Morphological features of H. aspergillata in culture (patient 1), showing septate conidiophores bearing conidiogenous hyphae disarticulating into rectangular and round-ended arthroconidia (3 to 4 μm). (C) CT scan (patient 1) showing a lung infiltrate. (D) Periodic acid-Schiff stain of lung biopsy specimen (patient 2) that shows septated (white arrowhead) and branched (black arrowhead) hyphae (magnification, ×400). (E) Gomori-Grocott stain of lung biopsy specimen (patient 1) showing septated and branched hyphae (magnification, ×100).