Successful Outcome of Disseminated Fusarium musae Fungemia with Skin Localization Treated with Liposomal Amphotericin B
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CASE REPORT
Successful Outcome of Disseminated Fusarium musae Fungemia with Skin Localization Treated with Liposomal Amphotericin B and Voriconazole in a Patient with Acute Myeloid Leukemia Vanessa Verbeke . Thibault Bourgeois . Tom Lodewyck . Jens Van Praet . Katrien Lagrou . Marijke Reynders . Eric Nulens
Received: 22 July 2020 / Accepted: 8 October 2020 Ó Springer Nature B.V. 2020
Abstract Fusarium spp. may cause invasive disseminated infections in immunocompromised patients, associated with significant morbidity and mortality. We describe a case of disseminated fusariosis with fungemia and skin localization caused by Fusarium musae in a patient with acute myeloid leukemia successfully treated using liposomal amphotericin B and voriconazole. Keywords Fusarium spp. Fungemia Leukemia Amphotericin B Voriconazole
Handling Editor: Ferry Hagen. V. Verbeke M. Reynders E. Nulens (&) Department of Medical Microbiology, AZ Sint-Jan Bruges, Ruddershove 10, 8000 Brugge, Belgium e-mail: [email protected] T. Bourgeois T. Lodewyck Department of Hematology, AZ Sint-Jan Bruges, Ruddershove 10, 8000 Brugge, Belgium J. Van Praet Department of Nephrology and Infectious Diseases, AZ Sint-Jan Bruges, Ruddershove 10, 8000 Brugge, Belgium K. Lagrou Department of Medical Microbiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
Case Report A 29-year-old Iraqi male without significant medical history was admitted because of severe B-symptoms, in particular night sweats and anorexia. The hematologic evaluation revealed a blood leukocyte count of 45,300 cells/ll with 91% blastic forms. Morphological examination and immunophenotyping on bone marrow coagulum confirmed the suspicion of AML with minimal maturation (AML-M1). Classical AML induction chemotherapy with daunorubicin and cytarabine was started. Oral ciprofloxacin 500 mg bid was administered for selective intestinal decontamination and fluconazole 200 mg bid as antifungal prophylaxis. Fever and hemodynamic instability shortly after the induction therapy motivated his transfer to the intensive care unit (ICU), and meropenem 1 g tid IV empirically started together with vancomycin in continuous infusion (recommended serum concentration: 20–25 mg/l). Blood cultures showed methicillin-sensitive Staphylococcus aureus, and antibiotic treatment continued for 14 days. Considering suspected tumor lysis syndrome, adding solumedrol 1 mg/kg yielded a positive clinical and biochemical evolution. A repeat bone marrow biopsy on day 14 of induction revealed refractory disease with 63% blasts. A second induction with idarubicin and high-dose cytarabine was started immediately, leading to prolonged myelosuppression. After 20 days of profound neutropenia, the patient
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Mycopathologia
redeveloped fever up to 40 °C without identifiable clinical signs (except for 3 small skin lesions on both legs), or computed tomography (CT) graphical abnormalities. Biochemically, high C-reactive protein (CRP) values up to 32
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