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Case Reports
. 2025 Apr 1;11(4):270.
doi: 10.3390/jof11040270.

Invasive Fungal Infection by Scedosporium apiospermum with Cerebral Involvement in a Pediatric Patient Affected by Chronic Granulomatous Disease After Hematopoietic Cell Transplant

Chiara Garonzi  1 , Matteo Chinello  1 , Giulia Caddeo  1 , Elisa Bonetti  1 , Maria Pia Esposto  1 , Vincenza Pezzella  1 , Virginia Vitale  1 , Ada Zaccaron  1 , Annarita Sorrentino  2 , Davide Gibellini  3 , Simone Cesaro  1
Affiliations
Case Reports

Invasive Fungal Infection by Scedosporium apiospermum with Cerebral Involvement in a Pediatric Patient Affected by Chronic Granulomatous Disease After Hematopoietic Cell Transplant

Chiara Garonzi et al. J Fungi (Basel). .

Abstract

A 5-year-old boy affected by chronic granulomatous disease (CGD) underwent two allogeneic hematopoietic cell transplants (HCT) from the same unrelated donor. The first HCT was complicated by prolonged fever and primary graft failure. While fully aplastic, the patient developed a disseminated infection by Scedosporium apiospermum involving the knee and parasternal skin (day +34 and +40 post-HCT). The patient was treated with voriconazole and granulocyte transfusions followed by a second HCT 80 days after the first HCT. At day +105, the patient developed fever, headache, and altered level of consciousness associated with multiple bilateral cerebral abscesses at magnetic resonance imaging. The serum B-D-glucan test was positive. Micafungin was added to voriconazole. Despite an initial clinical improvement, the patient developed hydrocephalus. Scedosporium apiospermum was cultured from cerebrospinal fluid. Liposomal amphotericin B, instead of micafungin, was combined with voriconazole as salvage therapy. Unfortunately, the patient developed uncal herniation and died at day +193 from HCT. This case shows that the prognosis of scedosporiosis remains poor despite adequate antifungal treatment. Noteworthy, the B-D-Glucan test is confirmed useful as a non-invasive marker for early diagnosis and may help the differential diagnosis of mycoses.

Keywords: Scedosporium apiospermum infection; allogeneic hematopoietic cell transplantation; chronic granulomatous disease; mycoses.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Scedosporium apiospermum on Sabouraud Dextrose agar culture (photography of culture plate, plate diameter: 8.5 cm).
Figure 2
Figure 2
Scedosporium apiospermum at microscopic examination (lactophenol cotton blue staining; microscope objective 25/0.63, eyepiece GF 12.5×/20).
Figure 3
Figure 3
Brain MRI ((a,b): different slices), day + 183 post-2nd HCT.
Figure 4
Figure 4
Serum B-D-glucan test results (Wako turbidimetric assay).
See this image and copyright information in PMC

References

    1. Fang W., Wu J., Cheng M., Zhu X., Du M., Chen C., Liao W., Zhi K., Pan W. Diagnosis of invasive fungal infections: Challenges and recent developments. J. Biomed. Sci. 2023;30:42. doi: 10.1186/s12929-023-00926-2. - DOI - PMC - PubMed
    1. McCarthy M.W., Kontoyiannis D.P., Cornely O.A., Perfect J.R., Walsh T.J. Novel Agents and Drug Targets to Meet the Challenges of Resistant Fungi. J. Infect. Dis. 2017;216((Suppl. S3)):S474–S483. doi: 10.1093/infdis/jix130. - DOI - PubMed
    1. Bupha-Intr O., Butters C., Reynolds G., Kennedy K., Meyer W., Patil S., Bryant P., Morrissey C.O., Australasian Antifungal Guidelines Steering Committee Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021. Intern. Med. J. 2021;51((Suppl. S7)):177–219. doi: 10.1111/imj.15592. - DOI - PubMed
    1. Cortez K.J., Roilides E., Quiroz-Telles F., Meletiadis J., Antachopoulos C., Knudsen T., Buchanan W., Milanovich J., Sutton D.A., Fothergill A., et al. Infections caused by Scedosporium spp. Clin. Microbiol. Rev. 2008;21:157–197. doi: 10.1128/CMR.00039-07. - DOI - PMC - PubMed
    1. Lamaris G.A., Chamilos G., Lewis R.E., Safdar A., Raad I.I., Kontoyiannis D.P. Scedosporium infection in a tertiary care cancer center: A review of 25 cases from 1989–2006. Clin. Infect. Dis. 2006;43:1580–1584. doi: 10.1086/509579. - DOI - PubMed

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