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Published on: March 22, 2012
Fatal disseminated fusarium infection in acute lymphoblastic leukaemia in complete remission
B Austen1, H McCarthy, B Wilkins
1Department of Haematology, Southampton General Hospital, Tremona Road, Southampton S016 6YD, UK. Belindadoc@aol.com
Abstract:
Fusarium species are increasingly recognised as serious pathogens in the immunocompromised. The outcome in the context of persistent severe neutropenia has been almost universally fatal. However, there have been several case reports of successful treatment if neutrophil recovery can be achieved. This report presents the case of a fatality that occurred despite neutrophil recovery. A 67 year old man developed disseminated fusariosis during the neutropenic phase of induction chemotherapy for acute lymphoblastic leukaemia. Fusarium dimerum was isolated from blood cultures. This species is highly unusual and very few case reports exist in the literature. An initial response to amphotericin treatment coincided with neutrophil recovery but a subsequent relapse occurred, despite adequate neutrophil counts, which proved fatal. It is postulated that reseeding of the blood from an occult site, namely the right vitreum in this case, led to this secondary relapse despite achieving complete leukaemic remission.
Insights
Disseminated fusariosis in immunocompromised patients is often fatal. This case highlights a rare fatality from Fusarium dimerum infection despite neutrophil recovery, suggesting occult reseeding caused relapse.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Fusarium species are emerging as significant pathogens, particularly in immunocompromised individuals.
- Disseminated fusariosis in patients with persistent severe neutropenia typically carries a universally fatal prognosis.
- Successful treatment has been reported in cases where neutrophil recovery is achieved.
Observation:
- This report details a fatal case of disseminated fusariosis in a 67-year-old male undergoing induction chemotherapy for acute lymphoblastic leukemia.
- The patient developed infection during the neutropenic phase, with Fusarium dimerum identified in blood cultures—a rarely reported species.
- An initial positive response to amphotericin B coincided with neutrophil recovery, but a secondary relapse occurred despite adequate neutrophil counts.
Findings:
- Despite achieving complete remission of leukemia and neutrophil recovery, the patient experienced a fatal relapse of fusariosis.
- The relapse is postulated to be due to reseeding of the bloodstream from an occult infection site, identified as the right vitreum.
- This case underscores the challenges in treating disseminated fusariosis, even with host immune recovery.
Implications:
- The findings suggest that occult fungal reservoirs can lead to secondary relapses in immunocompromised patients, even after initial treatment success and immune reconstitution.
- This case emphasizes the need for vigilance and potentially novel diagnostic or therapeutic strategies to address hidden fungal foci in disseminated fusariosis.
- Further research into the pathogenesis and management of Fusarium infections, especially in rare species like F. dimerum, is warranted.
