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Fusarium-Induced Cellulitis in an Immunocompetent Patient With Sickle Cell Disease: A Case Report
Shaher Samrah1, Aroob Sweidan1, Abdelwahab Aleshawi2
1Jordan University of Science and Technology, Irbid, Jordan.
Abstract:
Fungal infections due to Fusarium species are mostly present in immunocompromised and patients with poorly controlled diabetes mellitus. We report a case of lower extremity skin infection caused by Fusarium species in a 61-year-old woman diagnosed with sickle cell disease. Single skin ulceration caused by Fusarium species can result from fungal inoculation into damaged tissue, so any condition that damages the skin can be considered as a risk factor for inoculation. Long-standing sickle cell disease may develop vaso-occlusion in the skin that can produce lower extremity ulcers and myofascial syndromes. The mechanism is not completely characterized, but compromised blood flow, endothelial dysfunction, thrombosis, inflammation, and delayed healing are thought to contribute to locally compromised tissue that may eventually lead to opportunistic infection such as in our case. Other factors contribute to the pathophysiology of lower extremity ulcers such as diabetes mellitus, with the resulting peripheral vascular ischemia causing poor circulation to the lower extremity, and peripheral neuropathy, which can make patients with diabetes unaware of minor trauma leading to the development of skin infections.
Insights
Fusarium fungal infections can affect individuals with sickle cell disease, leading to lower extremity ulcers. This case highlights sickle cell disease as a risk factor for opportunistic Fusarium skin infections.
Area of Science:
- Mycology
- Infectious Diseases
- Dermatology
Background:
- Fusarium species commonly cause infections in immunocompromised individuals and those with uncontrolled diabetes mellitus.
- Lower extremity ulcers are frequently observed in patients with diabetes due to peripheral vascular ischemia and neuropathy.
- Sickle cell disease is increasingly recognized as a risk factor for opportunistic infections.
Observation:
- A 61-year-old woman with a history of sickle cell disease presented with a lower extremity skin ulcer.
- The ulcer was diagnosed as a fungal infection caused by Fusarium species.
- Sickle cell disease can lead to skin vaso-occlusion, potentially causing ulcers and predisposing to infection.
Findings:
- The case demonstrates Fusarium species causing a lower extremity skin infection in a patient with sickle cell disease.
- Compromised blood flow, endothelial dysfunction, and inflammation associated with sickle cell disease may contribute to tissue damage and opportunistic infections.
- Skin damage from any cause increases the risk of Fusarium inoculation and subsequent infection.
Implications:
- This case broadens the understanding of risk factors for Fusarium infections beyond traditional immunocompromised states.
- It underscores the importance of considering opportunistic fungal infections in patients with chronic conditions like sickle cell disease.
- Early recognition and management of skin lesions in sickle cell patients are crucial to prevent severe infections.
