Disseminated Fusarium infection is a rare but life-threatening disease in severely immunocompromised patients. We describe two patients with a Fusarium Solanii infection. Case 1. A 5,7 y old boy diagnosed with high risk pre-B ALL (WBC 133 X 109/l). He was treated according to the Nordic high risk ALL protocol. During induction, after 13 days of severe granulocytopenia, first signs of fungal infection appeared. The patient was febrile and had multiple skin lesions changing from a pustule through microabscesses to necrotic craters. Cultures from skin lesions, blood, throat, and stools were positive for Fusarium Solanii. He was treated with Liposomal amphotericin B (5-2.5 mg/kg/day) for nine months before an allo-BMT from unrelated donor (URD-BMT) was performed six months after the last positive culture of Fusarium Solanii. Treatment protocol was modified to avoid granulocytopenia. Amphotericin was continued post-BMT for six months. The patient developed severe acute and chronic graft-versus-host disease (GVHD) and died six months post-BMT. Autopsy was not performed. One to two months before his death both pharyngeal and fecal cultures were again transiently positive for Fusarium Solanii without any symptoms attributable to that. Clinically, he died in remission and without Fusarium infection. The cause of death was multiple organ failure caused by GVHD. Case 2. A boy with AML developed relapse at the age of 8,5 y, four months after which an URD-BMT was performed. He developed severe acute and chronic GVHD. Six months after BMT, small pustules were noticed in his skin. 10 days before his death fecal cultures were positive for Fusarium. He died 6,5 months after BMT due to multiple organ failure caused by rejection. Both cases coincided with construction work in our hospital in 1998-2000, and are the only ones ever recognized in our unit. We conclude that this rare fungus with the typical clinical picture needs to be kept in mind in units taking care of immunocompromised patients. Further, treatment of malignancy may be possible with aggressive antifungal therapy.
Full conference title:
44th Amercian Society of Hematology Annual Meeting
- ASH 44th (2002)