title: Rare case of disseminated fusariosis in a young patient with graft vs. host disease following an allogeneic transplant.
abstract: Fusariuminfection is a severe fungal infection caused by fungi of the genusFusarium. It most commonly occurs in immunocompromised patients with malignant hematological comorbidities or secondary to hematopoietic stem cell transplant. The classical route of contamination is through inhalation but infection may also occur through contiguity with a skin lesion. This report describes the case of a 24-year-old woman who developed graft-vs.-host disease (GVHD) at 220 days after receiving an allogeneic stem cell transplant from a sibling donor for Hodgkin disease. On day 330 after transplant the patient presented with fever and several painful subcutaneous, tender, red nodules with ulcerative and necrotic features on the pelvic region and right leg, extensive glass infiltrative lesions in the lungs and pansinusitis; however, the patient did not have onychomycosis. Following skin biopsy, culture of cutaneous lesions, computed tomography (CT) scanning of the lungs and CT scanning and magnetic resonance imaging of facial sinuses the patient was diagnosed with disseminatedFusariumspecies infection. Despite intensive treatment with voriconazole, the patient succumbed with respiratory insufficiency on day 400 after transplant. This case is noteworthy because the patient did not have any additional risk associated with the allogeneic transplant; there was no transplant mismatch, no severe neutropenia and no prior clinical signs of onychomycosis. The association of skin lesions with GVHD lesions increased the initial immunosuppression and delayed diagnosis.
authors.affiliation: Bone Marrow Transplant Center, Fundeni Clinical Institute, 022328 Bucharest, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Tanase
authors.affiliation: Bone Marrow Transplant Center, Fundeni Clinical Institute, 022328 Bucharest, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Colita
authors.affiliation: Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ianosi
authors.affiliation: Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Neagoe
authors.affiliation: Department of Dermatology, University of Medicine and Pharmacy 'Gr. T. Popa', 700115 Iasi, Romania.
authors.forename: Daciana Elena
authors.initials: DE
authors.lastname: Branisteanu
authors.affiliation: Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Calina
authors.affiliation: Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Anca Oana
authors.initials: AO
authors.lastname: Docea
authors.affiliation: Laboratory of Toxicology, Medical School, University of Crete, Voutes, Heraklion, 71409 Crete, Greece.
authors.forename: Aristidis
authors.initials: A
authors.lastname: Tsatsakis
authors.affiliation: Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
authors.forename: Simona Laura
authors.initials: SL
authors.lastname: Ianosi
keywords: allogeneic stem cell transplant; fusariosis; immunosuppression