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Fatal invasive cerebral Absidia corymbifera infection following bone marrow transplantation
P J Paterson1, S R Marshall, B Shaw
1Department of Haematology, Royal Free Hospital, London, UK.
Abstract:
A 56-year-old dairy farmer received a fully HLA matched unrelated donor marrow transplant for high risk CML in chronic phase. His early post-transplant course was complicated by a series of massive intracerebral bleeds and by sepsis related to a malignant otitis externa. The microbial pathogen isolated from ear swabs was found to be Absidia corymbifera, but CT scan at the time showed no intracerebral extension. Despite neutrophil engraftment and aggressive antifungal management he succumbed. Autopsy revealed invasion of Absidia into the brain from the ear. We speculate that colonisation by Absidia resulted from occupational exposure.
Insights
A dairy farmer developed a rare Absidia corymbifera brain infection after a stem cell transplant. Occupational exposure may have led to this fatal fungal invasion from the ear.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Hematopoietic stem cell transplantation (HSCT) is a life-saving procedure for high-risk hematologic malignancies.
- Patients undergoing HSCT are immunocompromised, increasing susceptibility to opportunistic infections.
- Chronic Myeloid Leukemia (CML) in chronic phase can necessitate HSCT for high-risk cases.
Observation:
- A 56-year-old dairy farmer with high-risk CML underwent a matched unrelated donor HSCT.
- Post-transplant complications included severe intracerebral hemorrhages and sepsis from malignant otitis externa.
- Absidia corymbifera was isolated from ear swabs, with no initial CT evidence of intracranial spread.
Findings:
- Despite neutrophil engraftment and antifungal therapy, the patient succumbed to the infection.
- Autopsy confirmed direct invasion of the brain by Absidia from the external ear.
- The fungal colonization is speculated to be linked to occupational exposure in a farming environment.
Implications:
- This case highlights a rare but devastating complication of invasive zygomycosis in an immunocompromised patient.
- Occupational exposure to environmental fungi like Absidia corymbifera poses a potential risk for farmers undergoing HSCT.
- Early recognition and aggressive management of otitis externa in immunocompromised individuals are critical to prevent systemic dissemination.