title: Endophthalmitis as primary clinical manifestation of fatal fusariosis in an allogeneic stem cell recipient.
abstract: The occurrence of infections due to previously rare opportunistic pathogens is increasing despite the use of novel treatment strategies for immunocompromised patients. Here, we report the case of a patient presenting with fever, muscle pain, and bilateral endophthalmitis after allogeneic hematopoietic stem cell transplantation. Fusarium solani was isolated from peripheral blood samples and identified as the cause of gradual bilateral vision loss, despite appropriate antifungal prophylaxis, and therapy including vitrectomy and intraocular instillation of antifungal agents. The patient became comatose; basal meningitis involving both optic nerves was suspected based on magnetic resonance tomography. The patient died 8 days later due to septic multi-organ failure. Autopsy revealed that both kidneys, but no other organs, were infiltrated by Fusarium. No fungus was found in cerebral tissues or cerebrospinal fluid. Our case demonstrates some of the typical clinical features of systemic fusariosis and its potentially fatal outcome. The clinical observations reported here may help clinicians caring for immunocompromised patients to accelerate diagnosis and initiate treatment early at the onset of this fatal complication, and highlight the urgent need for interdisciplinary management of invasive fusariosis.
authors.affiliation: Department of Internal Medicine II, Institute for Hygiene and Microbiology, Julius-Maximilians University, Wuerzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kapp
authors.forename: M
authors.initials: M
authors.lastname: Schargus
authors.forename: T
authors.initials: T
authors.lastname: Deuchert
authors.forename: J
authors.initials: J
authors.lastname: Springer
authors.forename: F
authors.initials: F
authors.lastname: Wendel
authors.forename: J
authors.initials: J
authors.lastname: Loeffler
authors.forename: G U
authors.initials: GU
authors.lastname: Grigoleit
authors.forename: O
authors.initials: O
authors.lastname: Kurzai
authors.forename: W
authors.initials: W
authors.lastname: Heinz
authors.forename: H
authors.initials: H
authors.lastname: Einsele
authors.forename: G
authors.initials: G
authors.lastname: Stuhler
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D017809:Fatal Outcome; D060585:Fusariosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D005670:Fusarium / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B