A long-term survivor of disseminated Aspergillus and mucorales infection: an instructive case

Area of Science:

• Mycology and Infectious Diseases
• Hematopoietic Stem Cell Transplantation (HSCT)
• Oncohematology

Background:

• Invasive fungal infections (IFIs) are a significant cause of mortality in hematopoietic stem cell transplantation (HSCT) recipients.
• Mixed fungal infections and multi-organ involvement are challenging clinical scenarios in this immunocompromised population.
• Relapsed acute myeloid leukemia (AML) increases the risk and complexity of managing IFIs post-HSCT.

Observation:

• A HSCT patient with relapsed AML developed a severe mixed infection involving Aspergillus and Mucorales species.
• The infection disseminated to multiple organs, including the lungs, brain, spleen, and bone.
• Cerebral abscesses were a critical complication requiring neurosurgical intervention.

Findings:

• The patient achieved long-term survival through a comprehensive treatment strategy.
• Successful management involved triple antifungal therapy combined with neurosurgical evacuation of brain abscesses.
• Lifelong secondary prophylaxis with posaconazole was well-tolerated for over 10 years, demonstrating excellent compliance and no toxicity.
• Serial galactomannan measurements and positron emission tomography/computed tomography (PET/CT) proved valuable for disease activity monitoring.

Implications:

• This case demonstrates the feasibility of achieving long-term survival in HSCT patients with severe, combined invasive mould infections.
• Aggressive multimodal therapy, including combination antifungals and surgical intervention, can be life-saving.
• Long-term secondary prophylaxis with posaconazole is a viable strategy for preventing relapse in high-risk patients.
• Advanced imaging and biomarker monitoring play a crucial role in managing complex IFIs.