Disseminated Saksenaea infection in an immunocompromised host associated with a good clinical outcome: a case report and review of the literature

Abstract

Background: Saksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown.

Case presentation: A 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived.

Conclusions: We describe an unusual case of disseminated infection with a favourable outcome to date.

Keywords: Amphotericin B; Disseminated fungal infection; Mucormycosis; Posaconazole.

Fig. 1

Abdominal wall lesion

Fig. 2

CT scan demonstrating absence of perfusion in the lower pole of the left kidney

Fig. 3

a Periodic acid-Schiff stain of skin biopsy from the abdominal wall, demonstrating broad, branching, aseptate fungal hyphae invading a blood vessel wall. b. Haematoxylin and eosin stain of a renal biopsy demonstrating broad, aseptate hyphae invading the renal tissue (Bar 20 mm A & B)