PresentationA 62-year-old male patient presents to the Emergency Department (ED) with a 3-day history of fever. After presentation in the ED the patient developed skin lesions which progressively worsened over time. The patient has a medical history of acute myeloid leukemia (AML) for which he received a stem cell transplant and chemotherapy.
Lab TestingBased on the clinical presentation of the patient, a skin biopsy was sent to pathology for special staining. Blood cultures were sent to microbiology along with bacterial and fungal cultures on the skin biopsy. The tissue stain showed the presence of fungal hyphae invading the blood vessels. Both the blood and fungal culture grew Fusarium spp.
Cause of SymptomsSoil saprophytes and plant pathogens such as Fusarium can be opportunistic pathogens in humans, most notably those that are immunocompromised. Because these organisms are found in the environment, clinical relevance is strong based on the presence of the organism in the tissue biopsy and when recovered from multiple specimens from the same patient. This patient had both invasive and disseminated disease based on the tissue biopsy but also the positive blood culture.
TreatmentTreatment for Fusarium is typically with lipid-based Amphotericin B. It is recommended that Voriconazole be added as combination therapy until speciation and susceptibility results are available. This patient was treated with 2 antifungals and recovered from the infection.
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