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Cutaneous Fusarium infection in an adolescent with acute leukemia
M Alvarez-Franco1, M Reyes-Mugica, A S Paller
1Department of Pediatrics, Children's Memorial Hospital, Northwestern University School of Medicine, Chicago, Illinois.
Abstract:
Disseminated fusariosis occurred in a pediatric patient with acute lymphocytic leukemia in relapse. The patient had fever and neutropenia, and scattered violaceous papules and vesicles with central erosions that rapidly progressed to generalized, painful, violaceous, papulovesicular lesions with central necrosis. Severe myalgias were associated. The diagnosis was suspected by noting hyphae on a smear of vesicular contents, and confirmed by culture. The clinical course was rapidly fatal despite early institution of amphotericin B therapy. Disseminated Fusarium infection should be suspected in immunocompromised patients with fever and neutropenia who have generalized, eroded, violaceous papules, vesicles, and pustules, particularly with associated myalgias.
Insights
Disseminated fusariosis, a fungal infection, rapidly affected a child with acute lymphocytic leukemia. Early amphotericin B treatment was ineffective, highlighting the aggressive nature of this infection in immunocompromised patients.
Area of Science:
- Mycology
- Pediatric Oncology
- Infectious Diseases
Background:
- Acute lymphocytic leukemia (ALL) is a common pediatric cancer.
- Patients with ALL, especially during relapse, are immunocompromised.
- Neutropenia is a frequent complication of ALL treatment, increasing infection risk.
Observation:
- A pediatric patient with relapsed ALL presented with fever and neutropenia.
- The patient developed rapidly progressing, painful, violaceous papulovesicular lesions with central necrosis and erosions.
- Severe myalgias were a notable associated symptom.
Findings:
- Hyphae observed on vesicular fluid smears suggested Fusarium infection.
- Fungal culture confirmed disseminated fusariosis.
- Despite prompt initiation of amphotericin B, the infection proved rapidly fatal.
Implications:
- Disseminated Fusarium infection should be considered in immunocompromised patients, particularly those with neutropenic fever.
- Characteristic skin lesions (eroded, violaceous papules/vesicles with necrosis) and myalgias are key diagnostic clues.
- The aggressive course underscores the challenge of treating fusariosis in severely immunocompromised hosts.