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Prolonged survival after disseminated Rhinocladiella infection treated with surgical excision and posaconazole
Nicola Hardman1, Nicola Young1, Richard Hobson1
1Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK.
Abstract:
Cerebral abscess due to pigmented molds is a rare but usually fatal infection occasionally seen in transplant recipients. A 67-year-old man of Iraqi origin underwent a deceased donation renal transplant for renal failure and 2 months later was diagnosed with an abscess in the left posterior frontal lobe of his brain. Subsequent biopsy proved this to be due to the mold Rhinocladiella mackenziei. Further interventions included two operations to aspirate the lesion, voriconazole, then liposomal amphotericin B, then a combination of posaconazole and flucytosine which he continued for over 4 years. He also suffered from right ankle pain and was diagnosed with septic arthritis; R mackenziei was isolated from pus aspirated from the ankle joint. He responded well to the treatment and has had little loss of function, and on CT, the cerebral lesion has stabilized. Beta-D-glucan, initially at very high levels proved useful to monitor response over the 5 years and the latest sample was negative (38 pg/mL). This case is notable for the first disseminated case of this infection, its favorable outcome on a novel antifungal combination and a new approach to monitoring the course of disease.
Insights
A rare brain infection caused by the mold Rhinocladiella mackenziei in a transplant patient was successfully treated with a novel antifungal combination. Beta-D-glucan levels effectively monitored the patient's response over five years.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neurosurgery
Background:
- Pigmented mold infections, such as cerebral abscesses, are rare and often fatal, particularly in immunocompromised individuals like transplant recipients.
- Rhinocladiella mackenziei is an emerging fungal pathogen causing opportunistic infections.
Observation:
- A 67-year-old renal transplant recipient developed a cerebral abscess and septic arthritis caused by Rhinocladiella mackenziei.
- The infection disseminated to both the brain and ankle, presenting a complex clinical challenge.
Findings:
- The patient was treated with a multi-year regimen including voriconazole, liposomal amphotericin B, and a novel combination of posaconazole and flucytosine.
- Cerebral lesion stabilization and a favorable outcome were achieved with the novel antifungal combination.
- Elevated Beta-D-glucan levels served as a reliable biomarker for monitoring treatment response over five years, eventually becoming negative.
Implications:
- This case highlights the first reported disseminated Rhinocladiella mackenziei infection with a favorable outcome.
- The successful use of a novel antifungal combination offers a potential new treatment strategy for such infections.
- The utility of Beta-D-glucan monitoring in managing disseminated fungal infections is demonstrated.
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