title: Phialophora verrucosa infection in a BMT patient.
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.
authors.affiliation: Detroit Medical Center, Wayne State University, MI 48201, USA.
authors.forename: T S
authors.initials: TS
authors.lastname: Lundstrom
authors.forename: M R
authors.initials: MR
authors.lastname: Fairfax
authors.forename: M C
authors.initials: MC
authors.lastname: Dugan
authors.forename: J A
authors.initials: JA
authors.lastname: Vazquez
authors.forename: P H
authors.initials: PH
authors.lastname: Chandrasekar
authors.forename: E
authors.initials: E
authors.lastname: Abella
authors.forename: C
authors.initials: C
authors.lastname: Kasten-Sportes
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008081:Liposomes / Q000627:therapeutic use; D009181:Mycoses / Q000150:complications / Q000401:mortality*; D009503:Neutropenia / Q000150:complications; D010676:Phialophora; D014132:Trachea / Q000098:blood supply
chemical_list: D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D000666:Amphotericin B