Rare case of disseminated fusariosis in a young patient with graft vs. host disease following an allogeneic transplant

Tanase,Alina; Colita,Anca; Ianosi,Gabriel; Neagoe,Daniela; Branisteanu,Daciana  Elena; Calina,Daniela; Docea,Anca  Oana; Tsatsakis,Aristidis; Ianosi,Simona  Laura

doi:10.3892/etm.2016.3562

Rare case of disseminated fusariosis in a young patient with graft vs. host disease following an allogeneic transplant

Authors:
- Alina Tanase
- Anca Colita
- Gabriel Ianosi
- Daniela Neagoe
- Daciana Elena Branisteanu
- Daniela Calina
- Anca Oana Docea
- Aristidis Tsatsakis
- Simona Laura Ianosi
View Affiliations

Affiliations: Bone Marrow Transplant Center, Fundeni Clinical Institute, 022328 Bucharest, Romania, Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Dermatology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iasi, Romania, Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Laboratory of Toxicology, Medical School, University of Crete, Voutes, Heraklion 71409, Greece, Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Published online on: August 1, 2016 https://doi.org/10.3892/etm.2016.3562
Pages: 2078-2082
Copyright: © Tanase et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Fusarium infection is a severe fungal infection caused by fungi of the genus Fusarium. It most commonly occurs in immunocompromised patients with malignant hematological comorbidities or secondary to hematopoietic stem cell transplant. The classical route of contamination is through inhalation but infection may also occur through contiguity with a skin lesion. This report describes the case of a 24-year-old woman who developed graft‑vs.‑host disease (GVHD) at 220 days after receiving an allogeneic stem cell transplant from a sibling donor for Hodgkin disease. On day 330 after transplant the patient presented with fever and several painful subcutaneous, tender, red nodules with ulcerative and necrotic features on the pelvic region and right leg, extensive glass infiltrative lesions in the lungs and pansinusitis; however, the patient did not have onychomycosis. Following skin biopsy, culture of cutaneous lesions, computed tomography (CT) scanning of the lungs and CT scanning and magnetic resonance imaging of facial sinuses the patient was diagnosed with disseminated Fusarium species infection. Despite intensive treatment with voriconazole, the patient succumbed with respiratory insufficiency on day 400 after transplant. This case is noteworthy because the patient did not have any additional risk associated with the allogeneic transplant; there was no transplant mismatch, no severe neutropenia and no prior clinical signs of onychomycosis. The association of skin lesions with GVHD lesions increased the initial immunosuppression and delayed diagnosis.

View Figures

View References

1	Nucci M, Marr KA, QueirozTelles F, Martins CA, Trabasso P, Costa S, Voltarelli JC, Colombo AL, Imhof A, Pasquini R, et al: Fusarium infection in hematopoietic stem cell transplant recipients. Clin Infect Dis. 38:1237–1242. 2004. View Article : Google Scholar : PubMed/NCBI
2	Marr KA, Carter RA, Crippa F, Wald A and Corey L: Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 34:909–917. 2002. View Article : Google Scholar : PubMed/NCBI
3	Galimberti R, Torre AC, Baztán MC and Rodriguez-Chiappetta F: Emerging systemic fungal infections. Clin Dermatol. 30:633–650. 2012. View Article : Google Scholar : PubMed/NCBI
4	Campo M, Lewis RE and Kontoyiannis DP: Invasive fusariosis in patients with hematologic malignancies at a cancer center: 1998-2009. J Infect. 60:331–337. 2010. View Article : Google Scholar : PubMed/NCBI
5	Stanzani M, Tumietto F, Vianelli N and Baccarani M: Update on the treatment of disseminated fusariosis: Focus on voriconazole. Ther Clin Risk Manag. 3:1165–1173. 2007.PubMed/NCBI
6	Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, et al: National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 11:945–956. 2005. View Article : Google Scholar : PubMed/NCBI
7	Girmenia C, Pagano L, Corvatta L, Mele L, del Favero A and Martino P: The epidemiology of fusariosis in patients with haematological diseases. Gimema Infection Programme. Br J Haematol. 111:272–276. 2000. View Article : Google Scholar : PubMed/NCBI
8	Minor RL Jr, Pfaller MA, Gingrich RD and Burns LJ: Disseminated Fusarium infections in patients following bone marrow transplantation. Bone Marrow Transplant. 4:653–658. 1989.PubMed/NCBI
9	Jain A, Jain S and Rawat S: Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention. J Pharm Bioallied Sci. 2:314–320. 2010. View Article : Google Scholar : PubMed/NCBI
10	Clemons KV, Calich VL, Burger E, Filler SG, Grazziutti M, Murphy J, Roilides E, Campa A, Dias MR, Edwards JE Jr, et al: Pathogenesis I: Interactions of host cells and fungi. Med Mycol. 38(Suppl 1): S99–S111. 2000. View Article : Google Scholar
11	Kontoyiannis DP, Bodey GP, Hanna H, Hachem R, Boktour M, Girgaway E, Mardani M and Raad II: Outcome determinants of fusariosis in a tertiary care cancer center: The impact of neutrophil recovery. Leuk Lymphoma. 45:139–141. 2004. View Article : Google Scholar : PubMed/NCBI
12	Nucci M, Anaissie EJ, QueirozTelles F, Martins CA, Trabasso P, Solza C, Mangini C, Simões BP, Colombo AL, Vaz J, et al: Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection. Cancer. 98:315–319. 2003. View Article : Google Scholar : PubMed/NCBI
13	Short DP, O'Donnell K, Zhang N, Juba JH and Geiser DM: Widespread occurrence of diverse human pathogenic types of the fungus Fusarium detected in plumbing drains. J Clin Microbiol. 49:4264–4272. 2011. View Article : Google Scholar : PubMed/NCBI
14	Pitt JI: Toxigenic fungi: Which are important? Med Mycol. 38(Suppl 1): S17–S22. 2000. View Article : Google Scholar
15	Perfect JR: The impact of the host on fungal infections. Am J Med. 125(Suppl): S39–S51. 2012. View Article : Google Scholar : PubMed/NCBI
16	Muhammed M, Coleman JJ, Carneiro HA and Mylonakis E: The challenge of managing fusariosis. Virulence. 2:91–96. 2011. View Article : Google Scholar : PubMed/NCBI
17	DePauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, et al: European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group: Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 46:1813–1821. 2008. View Article : Google Scholar : PubMed/NCBI
18	Hayden RT, Isotalo PA, Parrett T, Wolk DM, Qian X, Roberts GD and Lloyd RV: In situ hybridization for the differentiation of Aspergillus, Fusarium, and Pseudallescheria species in tissue section. Diagn Mo Pathol. 12:21–26. 2003. View Article : Google Scholar
19	Leal SM Jr, Vareechon C, Cowden S, Cobb BA, Latgé JP, Momany M and Pearlman E: Fungal antioxidant pathways promote survival against neutrophils during infection. J Clin Invest. 122:2482–2498. 2012. View Article : Google Scholar : PubMed/NCBI
20	Walsh TJ, Francesconi A, Kasai M and Chanock SJ: PCR and single-strand conformational polymorphism for recognition of medically important opportunistic fungi. J Clin Microbiol. 33:3216–3220. 1995.PubMed/NCBI
21	Hennequin C, Abachin E, Symoens F, Lavarde V, Reboux G, Nolard N and Berche P: Identification of Fusarium species involved in human infections by 28S rRNA gene sequencing. J Clin Microbiol. 37:3586–3589. 1999.PubMed/NCBI
22	Pfaller MA, Messer SA, Hollis RJ and Jones RN: SENTRY Participants Group: Antifungal activities of posaconazole, ravuconazole, and voriconazole compared to those of itraconazole and amphotericin B tested against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: Report from the SENTRY antimicrobial surveillance program, 2000. Antimicrob Agents Chemother. 46:1032–1037. 2002. View Article : Google Scholar : PubMed/NCBI
23	Nucci M and Anaissie E: Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: Implications for diagnosis and management. Clin Infect Dis. 35:909–920. 2002. View Article : Google Scholar : PubMed/NCBI
24	Bodey GP, Boktour M, Mays S, Duvic M, Kontoyiannis D, Hachem R and Raad I: Skin lesions associated with Fusarium infection. J Am Acad Dermatol. 47:659–666. 2002. View Article : Google Scholar : PubMed/NCBI
25	Segal BH, Almyroudis NG, Battiwalla M, Herbrecht R, Perfect JR, Walsh TJ and Wingard JR: Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostics adjuncts. Clin Infect Dis. 44:402–409. 2007. View Article : Google Scholar : PubMed/NCBI
26	Anaissie EJ, Kuchar RT, Rex JH, Francesconi A, Kasai M, Müller FM, Lozano-Chiu M, Summerbell RC, Dignani MC, Chanock SJ and Walsh TJ: Fusariosis associated with pathogenic Fusarium species colonization of a hospital water system: A new paradigm for the epidemiology of opportunistic mold infections. Clin Infect Dis. 33:1871–1878. 2001. View Article : Google Scholar : PubMed/NCBI
27	Raad I, Tarrand J, Hanna H, Albitar M, Janssen E, Boktour M, Bodey G, Mardani M, Hachem R, Kontoyiannis D, et al: Epidemiology, molecular mycology, and environmental sources of Fusarium infection in patients with cancer. Infect Control Hosp Epidemiol. 23:532–537. 2002. View Article : Google Scholar : PubMed/NCBI
28	Dannaoui E, DesnosOllivier M, GarciaHermoso D, Grenouillet F, Cassaing S, Baixench MT, Bretagne S, Dromer F and Lortholary O: French Mycoses Study Group: Candida spp. with acquired echinocandin resistance, France, 2004-2010. Emerg Infect Dis. 18:86–90. 2012. View Article : Google Scholar : PubMed/NCBI
29	Ho DY, Lee JD, Rosso F and Montoya JG: Treating disseminated fusariosis: Amphotericin B, voriconazole or both? Mycoses. 50:227–231. 2007. View Article : Google Scholar : PubMed/NCBI