Disseminated Fusarium infection with brain abscesses in a lung transplant recipient.
OBJECTIVE
To detail a case of disseminated Fusarium infection in an immunocompromised adult. Fusarium sp. infections are an important cause of fungal keratitis in immunocompetent patients and a recent outbreak related to use of a specific type of contact lens solution made national and international newspaper headlines. While reports of disseminated infection in immunosuppressed patients have appeared over the last 30 years, few have emphasized the neuropathological aspects of this emerging pathogen.


METHODS
Woman with pulmonary sarcoidosis necessitating bilateral lung transplants 4 months prior to her demise who was soon readmitted with viral pneumonia. She developed targetoid skin lesions of her face and thigh; she succumbed before biopsy could be performed.


RESULTS
Autopsy revealed systemic organ infection involving lungs, gastrointestinal tract mucosa, bilateral kidneys, and skin. Foci of acute cerebritis showed vessels occluded by hyphal, septate fungi. Fungal culture remains the gold standard for diagnosis, and culture grew Fusarium.


CONCLUSIONS
Fusarium is resistant to standard antifungal therapies; the increasing use of antifungal medications - as either treatment or prophylaxis - may shift more infections toward unusual species such as Fusarium.
Kleinschmidt-Demasters
B K
BK
Departments of Pathology, Neurology, and Neurosurgery, University of Colorado Health Sciences Center, Aurora, CO, USA. mk.demasters@ucdenver.edu
D001922:Brain Abscess / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D005670:Fusarium / Q000276:immunology / Q000472:pathogenicity*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000276:immunology*; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D017565:Sarcoidosis, Pulmonary / Q000601:surgery
D007166:Immunosuppressive Agents