Disseminated infection due to Scedosporium apiospermum in a patient with acute myelogenous leukemia.
A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. Fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and Scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. Itraconazole and amphotericin B were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.
Ochiai
Naoya
N
Second Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyoku, Kyoto 602-8566, Japan. naoya@gemini.kpu-m.ac.jp
Shimazaki
Chihiro
C
Uchida
Ryo
R
Fuchida
Shin-Ichi
S
Okano
Akira
A
Ashihara
Eishi
E
Inaba
Tohru
T
Fujita
Naohisa
N
Nakagawa
Masao
M
D000666:Amphotericin B / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015299:Discitis / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis; D010019:Osteomyelitis / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology; D021681:Scedosporium; D018805:Sepsis / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology*
D017964:Itraconazole; D000666:Amphotericin B