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Paecilomyces lilacinus infection in a child with chronic granulomatous disease
C C Silliman1, D W Lawellin, J A Lohr
1Department of Pediatrics, University of Colorado School of Medicine, Denver 80262.
Insights
This case study details a child with Chronic Granulomatous Disease (CGD) experiencing rare abdominal abscesses from Paecilomyces lilacinus. Amphotericin B successfully treated this unusual fungal infection in an immunocompromised patient.
Area of Science:
- Immunology
- Infectious Diseases
- Mycology
Background:
- Chronic Granulomatous Disease (CGD) is a primary immunodeficiency affecting neutrophil function.
- Neutrophils are critical for host defense against fungal and bacterial pathogens via the respiratory burst.
- Impaired superoxide anion generation in CGD predisposes patients to recurrent, severe infections.
Observation:
- A pediatric patient with CGD presented with two abdominal wall abscesses.
- The abscesses were caused by Paecilomyces lilacinus, a fungus rarely implicated in CGD infections.
- Abdominal wall infections are an uncommon presentation for Paecilomyces.
Findings:
- Parenteral amphotericin B therapy was effective in eradicating the Paecilomyces lilacinus infection.
- This treatment regimen has historically shown limited success for similar infections.
- The case highlights the potential pathogenicity of fungi often considered contaminants in immunocompromised hosts.
Implications:
- Clinicians should consider Paecilomyces species as potential pathogens in immunocompromised patients, including those with CGD.
- Careful investigation of fungal isolates from immunocompromised hosts is crucial for accurate diagnosis and treatment.
- Successful treatment with amphotericin B suggests a viable therapeutic option for rare Paecilomyces infections in CGD.
Abstract:
Chronic granulomatous disease (CGD) is a rare inherited disorder in which neutrophils do not appropriately generate cytotoxic superoxide anion, the respiratory burst, in response to invading bacteria or fungi as a part of normal host defence. We report the case of a child with CGD who had two abdominal wall abscesses caused by Paecilomyces lilacinus, an organism not previously known to cause infections in patients with CGD. The abdominal wall is a location that is rarely associated with Paecilomyces infections. Parenteral amphotericin B eradicated the infection in an immunocompromised child whereas this regimen has heretofore largely been unsuccessful in the treatment of this infection. Paecilomyces species and other fungi from immunocompromised hosts and thought to be laboratory contaminants, need to be carefully investigated for they may become pathogens in this clinical setting.