Invasive mycoses are frequent complications in children with hematological malignancies. Candida and Aspergillus spp. are most common pathogens. The role of other fungi is not studied enough. Aim: To present a case of successful treatment of invasive mycosis caused by rare mold Paecilomyces lilacinus. Case report: A 13 years old boy with acute lymphoblastic leukemia received intensive cytostatic therapy in 2011. During febrile neutropenia (> 3 weeks) he was treated empirically with antibacterials (cephotaxim, ciprofloxacin, vancomicin) and amphotericin B. On this background, without any symptoms of pain and bleeding, unilateral (left) affection of soft tissues of the nose developed swiftly (during 1 day). Spontaneous perforation of the nasal septal cartilage was revealed. Direct microscopy of the nasal smear and histopathology of the damaged cartilage showed numerous hyaline septate branching hyphae. P. lilacinus was isolated from the nasal swab. Species identification was confirmed by ITS-region sequencing. Galactomannan test in serum was negative. CT scan of sinuses revealed destruction of the septal cartilage. The patient was treated with voriconazole during 80 days. His clinical condition was stable without any signs of dissemination of infection. Surgical intervention was not implemented. Conclusion: P. lilacinus was a causative agent of invasive mycosis in a pediatric patient with acute lymphoblastic leukemia. The disease affected nasal soft tissues and cartilage. Voriconazole therapy was successful.
Full conference title:
18th International Society for Human and Animal Mycology
- ISHAM 18th (2012)