Disseminated fusariosis in a patient with bone marrow aplasia

Abstract

Fusariosis is a superficial or systemic infection, which occurs mainly in immunocompromised hosts, especially in patients with hematological neoplasia; 70%-75% of the cases present cutaneous manifestations. The disseminated form is rare and difficult to diagnose; even with specific treatment, the evolution is usually fatal. Currently, it is considered an emerging disease; in some centers, it is the second most common cause of invasive mycosis, after aspergillosis. The authors describe a case of a female patient with idiopathic bone marrow aplasia and disseminated fusariosis, who initially appeared to benefit from voriconazole and amphotericin B; however, due to persistent neutropenia, her clinical condition deteriorated with fatal evolution.

Keywords: Fusariosis; Immunosuppression; Mycoses; Neutropenia.

Figure 1

A, An erythematous-violaceous macula on the left upper limb. B, After one week, the lesion evolved to ulceration with a necrotic center and slight erythema around it.

Figure 2

Histopathological examination of a lesion of the left upper limb, showing multiple septate, hyaline, and branched hyphae with angiolymphatic invasion. (A, Hematoxylin & eosin, ×10; B, Grocott, ×40).

Figure 3

A, Skin fragment culture in Sabouraud’s medium with chloramphenicol: white powdery filamentous colony; B, Lilac-colored pigmentation on the reverse side.

Figure 4

A, Direct examination of the skin lesion showing a large number of filamentous fungi; B, Microculture of the colony stained by lactophenol cotton blue, with macroconidia featuring characteristic canoe-type morphology.

Figure 5

A, Paronychia in the second and third left fingers; B, Exuberant livedo reticularis affecting the entire lower limb.

Figure 6

A, Chest tomography showing a pattern of parenchymal consolidation with intermingled air bronchograms, notably in the posterior region of the pulmonary fields (black arrows). (B, C, and D) CT scan of the sinuses showing diffuse veiling of the paranasal sinuses, characterized by material with soft tissue density filling the maxillary (red arrow), sphenoid (yellow arrow), and frontal sinuses (blue arrow), and the ethmoidal cells (white arrow).