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Case Reports
. 2024 Oct 29;11(11):ofae647.
doi: 10.1093/ofid/ofae647. eCollection 2024 Nov.

Lethal Disseminated Mucorales Infection With Positive Blood Cultures With Purpura Fulminans Complicating Hemophagocytic Lymphohistiocytosis After Chimeric Antigen Receptor T-Cell Therapy

Takahiro Matsuo  1 , Sebastian Wurster  1 , Doina Ivan  2 , Rachel Hicklen  3 , Kelly McConn  1 , Kelli A Bagwell  1 , Fareed Khawaja  1 , Roy F Chemaly  1 , Dimitrios P Kontoyiannis  1
Affiliations
Case Reports

Lethal Disseminated Mucorales Infection With Positive Blood Cultures With Purpura Fulminans Complicating Hemophagocytic Lymphohistiocytosis After Chimeric Antigen Receptor T-Cell Therapy

Takahiro Matsuo et al. Open Forum Infect Dis. .

Retraction in

Abstract

We report a case of fulminant Mucorales fungemia in a heavily immunosuppressed cancer patient with hemophagocytic lymphohistiocytosis following CD70-targeted chimeric antigen receptor T-cell therapy. Although rare, Mucorales can cause true fungemia in a broad spectrum of hosts, with a range of manifestations from isolated fungemia to fungemia being part of widely disseminated, high-burden infection.

Keywords: CAR T-cell therapy; Mucor species; fungemia; hemophagocytic lymphohistiocytosis.

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Conflict of interest statement

Potential conflicts of interest. D. P. K. received research support from Gilead Sciences and Astellas Pharma; received consultant fees from Astellas Pharma, Merck, Matinas, Basilea, Knight, Inc, and Gilead Sciences; and is a member of the data review committee for Cidara Therapeutics, AbbVie, Scynexis, and the Mycoses Study Group. R. F. C. received consultant fees from ADMA Biologics, Janssen, Merck/MSD, Partner Therapeutics, Takeda, Shinogi, AiCuris, Roche/Genentech, Astellas, Adagio Therapeutics, Tether, Oxford Immunotec, Karius, Moderna, InflaRX, and Ansun Pharmaceuticals. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Clinical course of a 68-year-old man with mucormycosis and hemophagocytic lymphohistiocytosis following chimeric antigen receptor T-cell therapy for renal cell carcinoma. Abbreviations: AK100/200/600, anakinra 100/200/600 mg/day; ANFG, anidulafungin; CAR-T, chimeric antigen receptor T-cell therapy; CFPM, cefepime; COVID-19, coronavirus disease 2019; CPFG, caspofungin; Cx, culture; D12/20/30/40/60, dexamethasone 12/20/30/40/60 mg/day; DAP, daptomycin; DOXY, doxycycline; FLCZ, fluconazole; HLH, hemophagocytic lymphohistiocytosis; ICANS, immune effector cell–associated neurotoxicity syndrome; ISA, isavuconazole; L-AMB, liposomal amphotericin B; LFT, liver function tests; LVFX, levofloxacin; MDA, MD Anderson Cancer Center; MEPM, meropenem; MINO, minocycline; MRI Abd, magnetic resonance imaging of the abdomen; OSH, outside hospital; P/T, piperacillin/tazobactam; PICC, peripherally inserted central catheter; PSCZ, posaconazole; REM, remdesivir; RX10/20, ruxolitinib 10/20 mg/day; VACV, valacyclovir; VCM, vancomycin.
Figure 2.
Figure 2.
A and B, On day 151 after chimeric antigen receptor T-cell therapy, the patient developed rapidly progressing nasal purpura and ischemia on the face around the nose and sinuses, chest, and extremities. C and D, Histopathology of skin biopsy showed fungal hyphae within vascular spaces and extensive dermal purpura (periodic acid-Schiff and Grocott methenamine stain, respectively).
See this image and copyright information in PMC

References

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