Lichtheimia Infection in a Lymphoma Patient: Case Report and a Brief Review of the Available Diagnostic Tools.
We describe the case of a patient with a T-lymphoblastic lymphoma whose disseminated mucormycosis was diagnosed with delay, and we address the diagnostic and therapeutic decision-making process and review the diagnostic workup of patients with potential IFD. The diagnosis was delayed despite a suggestive radiological presentation of the patient's pulmonary lesion. The uncommon risk profile (T-lymphoblastic lymphoma, short neutropenic phases) wrongly led to a low level of suspicion. The diagnosis was also hampered by the lack of indirect markers for infections caused by Mucorales, the low sensitivity of both fungal culture and panfungal PCR, and the limited availability of species-specific PCR. A high level of suspicion of IFD is needed, and aggressive diagnostic procedures should be promptly initiated even in apparently low-risk patients with uncommon presentations. The extent of the analytical workup should be decided on a case-by-case base. Diagnostic tests such as the galactomannan and β-D-glucan test and/or PCR on biological material followed by sequencing should be chosen according to their availability and after evaluation of their specificity and sensitivity. In high-risk patients, preemptive therapy with a broad-spectrum mould-active antifungal agent should be started before definitive diagnostic findings become available.
Department of Infectious Diseases, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. stefan.zimmerli@insel.ch.
Stefan
S
Zimmerli
LADR GmbH MVZ Dr. Kramer and Kollegen, Lauenburger Straße 67, 21502, Geesthacht, Germany.
Ralf
R
Bialek
Charité University Hospital, Benjamin Franklin Campus, Hindenburgdamm 30, 12200, Berlin, Germany.
Igor W
IW
Blau
Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Andreas
A
Christe
Division of Hygiene and Medical Microbiology, Medical University, Schöpfstr. 41, 6020, Innsbruck, Austria.
Cornelia
C
Lass-Flörl
Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Elisabeth
E
Presterl
D004271:DNA, Fungal / Q000032:analysis / Q000737:chemistry / Q000235:genetics; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011509:Proteoglycans; D017422:Sequence Analysis, DNA; D047071:beta-Glucans / Q000032:analysis
D004271:DNA, Fungal; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K
Diagnosis; Emerging risk groups; Molecular biology; Mucorales; Mucormycosis