Neutropenic patient presented with subcutaneous nodules

Abstract

BACKGROUND: Fusarium spp. is the second most-common mold infection in immunocompromised patients. Disseminated fusariosis is life-threatening and the outcome is influenced by the host’s immune status. Mortality ranges from 50-80%. Prolonged and profound neutropenia is a major risk factor. We report the first case of disseminated fusariosis with Fusarium aquaeductuum in Sri Lanka. CASE REPORT: A 5 1/2 year old boy with acute lymphoblastic leukemia (ALL) after completing chemotherapy was admitted with a relapse after 6 months. On admission he was asymptomatic. But the absolute neutrophil count was 650/L. He was started with IV vancomycin and IV ciprofloxacin empirically. While on those two antibiotics for 11 days, fever spikes appeared and meropenem and IV fluconazole were added. Fever continued and after 2 days he developed multiple painful subcutaneous nodules about 2cm in radius, mainly on limbs. Blood culture was positive for branching fungal filaments and it was later identified as Fusarium aquaeductuum.IV amphotericin B (conventional) was started and oral voriconazole was added after 2 days and both were continued for a total of 2 weeks after negative repeat blood cultures. CONCLUSIONS: Our patient was started on amphotericin B, with high clinical suspicion. Voriconazole was added due to initial poor response and positive repeat blood cultures. Although the mortality rate following disseminated fusariosis ranges 50% to 80%, with timely management our patient fully recovered.