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Phialophora verrucosa infection in a BMT patient
T S Lundstrom1, M R Fairfax, M C Dugan
1Detroit Medical Center, Wayne State University, MI 48201, USA.
Abstract:
Phialophora is a dematiaceous fungus isolated from soil and wood. Human infections including chromoblastomycosis, mycotic keratitis, cutaneous infections, and prosthetic valve endocarditis have been reported. We report a case of fatal hemorrhage due to Phialophora verrucosa in a patient with prolonged neutropenia undergoing autologous bone marrow transplant (BMT) for acute myelogenous leukemia (AML). Bacterial infections complicated induction and consolidation chemotherapies. Liposomal amphotericin B (LAMB) was given from day +33 to day +72 for febrile neutropenia. Death occurred on day +74 due to tracheal hemorrhage. Autopsy revealed granulation tissue on the posterior wall of the trachea with fungal hyphae on histopathology; the tissue grew Phialophora verrucosa. In vitro susceptibility studies revealed a minimum inhibitory concentration to AmB of 0.1 microg/ml. This represents the first reported case of invasive P. verrucosa in a BMT patient leading to fatal hemorrhage, despite large cumulative doses of LAMB to which the organism remained susceptible.
Insights
A fatal hemorrhage caused by Phialophora verrucosa occurred in a bone marrow transplant (BMT) patient with acute myelogenous leukemia (AML). This invasive fungal infection was resistant to treatment despite high doses of liposomal amphotericin B.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Phialophora is a fungus found in soil and wood, known to cause human infections like chromoblastomycosis and keratitis.
- Invasive fungal infections pose a significant risk to immunocompromised patients, particularly those undergoing hematopoietic stem cell transplantation.
Observation:
- A case of fatal tracheal hemorrhage is described in a patient with acute myelogenous leukemia (AML) undergoing autologous bone marrow transplant (BMT).
- The patient experienced prolonged neutropenia and secondary bacterial infections, complicated by a Phialophora verrucosa infection.
- Despite treatment with liposomal amphotericin B (LAMB), the patient succumbed to hemorrhage.
Findings:
- Autopsy revealed tracheal granulation tissue with fungal hyphae, identified as Phialophora verrucosa.
- In vitro studies demonstrated susceptibility to amphotericin B (AmB) with a minimum inhibitory concentration of 0.1 microg/ml.
- This is the first reported case of invasive P. verrucosa causing fatal hemorrhage in a BMT patient.
Implications:
- This case highlights the potential for severe, fatal invasive fungal infections in BMT recipients, even with appropriate antifungal therapy.
- It underscores the need for vigilance and prompt diagnosis of fungal infections in immunocompromised patients.
- Further research into optimal treatment strategies for invasive Phialophora infections in transplant patients may be warranted.