Atypical Clinical Presentation of a Newer Generation Anti-Fungal Drug-Resistant Fusarium Infection After a Modified Multi-Visceral Transplant.
BACKGROUND Fusarium spp. infections have become an emerging and lethal threat to the immunocompromised patient population, especially those with neutropenia. Recently there have been increased reports in solid organ transplant recipients. Presentation is commonly as soft tissue infections several months post-transplant. With high morbidity and mortality, efficacious antifungal therapy is essential. This remains challenging with limited data and no established clinical breakpoints defined. CASE REPORT We report on a modified multi-visceral transplant patient that developed a Fusarium infection only 7 weeks post-transplant in the native hard palate and esophagus, without any soft tissue lesions, which persisted despite aggressive combination treatment with amphotericin B lipid complex and voriconazole. CONCLUSIONS Fusarium spp. infection in solid organ transplant is a significant challenge without clear diagnostic clinical indicators of infection, or specific time of onset, in addition to possible emergence of a more aggressive drug-resistant strain.
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Ahmed
A
Kandeel
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Kareem
K
Abu-Elmagd
Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
Michael
M
Spinner
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Ajai
A
Khanna
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Koji
K
Hashimoto
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Masato
M
Fujiki
Department of Gastrointestinal, Cleveland Clinic, Cleveland, OH, USA.
Mansiur
M
Parsi
Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
Ana
A
Bennett
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Galal
G
El-Gazzaz
Department of Multi-Visceral Transplant, Cleveland Clinic, Cleveland, OH, USA.
Ahmed
A
Abd-Elaal
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D025141:Drug Resistance, Fungal; D004947:Esophagus / Q000637:transplantation*; D017809:Fatal Outcome; D005260:Female; D060585:Fusariosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D021362:Palate, Hard / Q000637:transplantation*; D017211:Treatment Failure; D065819:Voriconazole / Q000627:therapeutic use
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole