Rhizomucor and scedosporium infection post hematopoietic stem-cell transplant

Area of Science:

• Medical Mycology
• Transplant Infectious Diseases
• Hematology

Background:

• Hematopoietic stem-cell transplantation (HSCT) recipients are immunocompromised, increasing susceptibility to opportunistic infections.
• Invasive fungal infections (IFIs) pose a significant threat, contributing to morbidity and mortality in this patient population.
• Aplastic anemia is a condition requiring intensive treatment, including HSCT, which further elevates infection risk.

Observation:

• A 17-year-old male with severe aplastic anemia developed invasive fungal infections 6 and 8 months post-allogeneic HSCT.
• The patient experienced fungal pneumonitis caused by Rhizomucor sp. and rhinoencephalitis caused by Scedosporium apiospermum.
• These infections occurred despite HSCT from an HLA-matched unrelated donor.

Findings:

• The case illustrates rare co-infections with distinct fungal pathogens, Rhizomucor (mucormycosis) and Scedosporium (scedosporiosis), in an HSCT recipient.
• Clinical presentation included pulmonary and central nervous system involvement, underscoring the diverse manifestations of IFIs.
• Risk factors for IFIs in HSCT recipients, such as prolonged neutropenia and graft-versus-host disease, are critical considerations.

Implications:

• Early and accurate diagnosis of IFIs, including identification of specific fungal agents, is crucial for effective management.
• Integrated treatment strategies involving antifungal therapy, surgical intervention, and addressing predisposing factors are essential for improving outcomes.
• This case emphasizes the need for heightened vigilance and tailored antifungal prophylaxis/treatment protocols for HSCT recipients at risk for mucormycosis and scedosporiosis.