Isavuconazole Breakthrough Disseminated *Fusarium fujikuroi* Infection in a Patient with Allogeneic Hematopoietic Stem Cell Transplant: Diagnostic and Therapeutic Challenges – A Case Report
# Introduction This case report illustrates the diagnostic challenges and complexities in the treatment of disseminated fusariosis. # Case Presentation An 18-year-old patient received a second allogeneic hematopoietic stem cell transplant (HSCT) 5 months after the first HSCT. Two days post-transp...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
THE HEALTHBOOK COMPANY LTD.
2023-03-01
|
| Series: | healthbook TIMES. Oncology Hematology |
| Online Access: | https://doi.org/10.36000/HBT.OH.2023.15.100 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | # Introduction
This case report illustrates the diagnostic challenges and complexities in the treatment of disseminated fusariosis.
# Case Presentation
An 18-year-old patient received a second allogeneic hematopoietic stem cell transplant (HSCT) 5 months after the first HSCT. Two days post-transplant, the patient presented neutropenic fever with diffuse multiple cutaneous papular lesions under isavuconazole prophylaxis. A diagnosis of disseminated fusariosis due to *Fusarium fujikoroi* was established. Antifungal therapy had to be adapted multiple times for efficacy and safety issues. Long-term combination therapy with posaconazole and terbinafine efficiently controlled the infection and was well tolerated.
# Discussion
This case report illustrates three major teaching points: (i) high clinical suspicion based on typical clinical and microbiologic findings is a key factor for the diagnosis of fusariosis; (ii) treatment is challenging due to variable antifungal agent minimal inhibitory concentrations (MICs); and (iii) long-term administration of voriconazole can be associated with multiple, less frequently seen adverse events.
# Conclusion
Typical skin lesions and positive blood cultures for molds should promptly rise suspicion of fusariosis. Amphotericin-B and voriconazole are the first-line agents for the treatment of fusariosis. Second-line agents such as posaconazole and terbinafine can be used.
PEER REVIEWED ARTICLE |
|---|---|
| ISSN: | 2673-2092 2673-2106 |