A disseminated infection with the antifungal-multiresistant teleomorphic fungus Neocosmospora vasinfecta in a patient with acute B-lymphoblastic leukemia

Abstract

We report on a fatal invasive infection due to the ascomycetous fungus Neocosmospora vasinfecta, in a 20-year-old European patient suffering from an acute lymphoblastic leukemia. The infection could not be controlled by a bitherapy combining liposomal amphotericin B and voriconazole. This is the second case of disseminated infection reported with this unusual fungus, which develops under its teleomorphic state, is fully resistant to all systemic antifungals, and which is known to live in tropical countries.

Keywords: Antifungal-resistance; Invasive fungal infection; Neocosmospora vasinfecta; Teleomorph.

Fig. 1

Neocosmospora vasinfecta (a) mycelium growing on Sabouraud-Chloramphenicol-cycloheximide medium after 10 days incubation at 25 °C. (b) Mycelium differentiating numerous orange perithecia on Sabouraud-Chloramphenicol-cycloheximide medium after 15 days incubation at 25 °C. (c) Hyaline hyphae with one polyphialide, and two-septate fusoïd conidia (1200×). (d) Hyaline hyphae with monophialides and one-celled conidia with truncated base (600×). (e) Hyaline hyphae with solitary or branched aciculate phialides, fusoïd conidia, and numerous thick-walled ascospores (400×). (f) Isolated perithecia (100×). (g) Periphyses constituting the neck of the opercula of the perithecium through which ascospores are released when matures (400×). (h) Content of a young perithecium, showing cylindrical asci containing eight ascospores (100×).