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Fusarium meningoencephalitis in a child with acute leukemia
D P Agamanolis1, D K Kalwinsky, C E Krill
1Department of Pathology and Pediatrics (Hematology-Oncology), Children's Hospital Medical Center, Akron, Ohio.
Abstract:
A 15-year-old boy with acute lymphoblastic leukemia (ALL) developed disseminated fusarium infection with meningoencephalitis following a contaminated skin wound. With antifungal therapy, the cutaneous lesions cleared but central nervous system (CNS) infection persisted causing a fibrosing meningitis and a brain granuloma. Fusaria are soil saprophytes that are more commonly associated with superficial eye and skin lesions, but may also cause severe systemic infections with CNS involvement in immuno-compromised patients. The organism may be confused with Aspergillus in tissue sections, and can only be diagnosed by culture.
Insights
A boy with acute lymphoblastic leukemia (ALL) experienced a disseminated Fusarium infection. Antifungal treatment resolved skin lesions but a persistent central nervous system (CNS) infection caused meningitis and a brain granuloma.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Fusarium species are soil fungi.
- They typically cause superficial infections but can lead to severe systemic disease in immunocompromised individuals.
- Acute lymphoblastic leukemia (ALL) is a condition that weakens the immune system.
Observation:
- A 15-year-old boy with ALL developed a disseminated Fusarium infection after a contaminated skin wound.
- Cutaneous lesions initially responded to antifungal therapy.
- However, the central nervous system (CNS) infection persisted, leading to fibrosing meningitis and a brain granuloma.
Findings:
- Fusarium can cause severe CNS infections, including meningoencephalitis, in immunocompromised patients.
- The infection can manifest as fibrosing meningitis and brain granulomas.
- Diagnosis can be challenging as Fusarium may resemble Aspergillus in tissue samples and requires fungal culture.
Implications:
- This case highlights the potential for Fusarium to cause severe, invasive CNS infections in immunocompromised hosts.
- Early recognition and appropriate antifungal therapy are crucial for managing disseminated Fusarium infections.
- Accurate species identification through culture is essential for effective treatment and differentiating from other fungal pathogens.