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Disseminated Fusarium infection with brain abscesses in a lung transplant recipient
1Departments of Pathology, Neurology, and Neurosurgery, University of Colorado Health Sciences Center, Aurora, CO, USA. mk.demasters@ucdenver.edu
Objective:
To detail a case of disseminated Fusarium infection in an immunocompromised adult. Fusarium sp. infections are an important cause of fungal keratitis in immunocompetent patients and a recent outbreak related to use of a specific type of contact lens solution made national and international newspaper headlines. While reports of disseminated infection in immunosuppressed patients have appeared over the last 30 years, few have emphasized the neuropathological aspects of this emerging pathogen.
Patient And Methods:
Woman with pulmonary sarcoidosis necessitating bilateral lung transplants 4 months prior to her demise who was soon readmitted with viral pneumonia. She developed targetoid skin lesions of her face and thigh; she succumbed before biopsy could be performed.
Results:
Autopsy revealed systemic organ infection involving lungs, gastrointestinal tract mucosa, bilateral kidneys, and skin. Foci of acute cerebritis showed vessels occluded by hyphal, septate fungi. Fungal culture remains the gold standard for diagnosis, and culture grew Fusarium.
Conclusion:
Fusarium is resistant to standard antifungal therapies; the increasing use of antifungal medications - as either treatment or prophylaxis - may shift more infections toward unusual species such as Fusarium.
Insights
Disseminated Fusarium infection occurred in an immunocompromised adult lung transplant recipient. This case highlights Fusarium
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host Pathogens
Background:
- Fusarium species are a significant cause of fungal keratitis in immunocompetent individuals.
- Disseminated Fusarium infections are increasingly reported in immunosuppressed patients.
- Neuropathological aspects of disseminated Fusarium infections are underemphasized.
Observation:
- A patient with pulmonary sarcoidosis underwent bilateral lung transplants.
- The patient developed viral pneumonia and targetoid skin lesions.
- Autopsy revealed systemic organ involvement, including cerebritis.
Findings:
- Autopsy confirmed disseminated Fusarium infection involving lungs, GI tract, kidneys, and skin.
- Cerebral vessels were occluded by septate hyphae, indicative of fungal invasion.
- Fungal cultures isolated Fusarium species, confirming the diagnosis.
Implications:
- Fusarium demonstrates resistance to standard antifungal treatments.
- Increased use of antifungal prophylaxis or treatment may drive infections by unusual fungal species like Fusarium.
- This case underscores the importance of considering Fusarium in disseminated fungal infections in immunocompromised individuals.
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The first classification is based on the development of the disease, and it includes the following categories: