Disseminated fusariosis presenting with pulmonary nodules following a line infection

Abstract

A 54 year-old male with severe emphysema steroiddependent was admitted to the hospital with perforated diverticulitis. Ten days following surgery and placement of a central venous catheter for antibiotic administration, the patient developed fever, chills, dyspnea, and nonproductive cough. Imaging studies demonstrated bilateral pulmonary nodules, including some with cavitation (Figure 1). Blood cultures grew a mold, which was later identified as Fusarium sp. (Figures 2-4). The patient's central line was removed and he was treated with intravenous voriconazole for 14 days. Cultures of the catheter tip again revealed Fusarium sp. Fusarium spp. are common soil saprophytes that are associated with human infections both locally and systemically. Patients at most risk for disseminated fusariosis are those who are immunosuppressed, including those with neutropenia and patients being treated with corticosteroids or other immunosuppressive agents. The presentation is

Fusarium Infection

“…We identified 97 cases of invasive fusariosis from the literature published since 2000. 1 – 4 , 6 – 13 , 16 , 18 , 20 – 27 , 31 – 33 , 37 – 39 , 42 – 44 , 46 , 48 , 50 – 57 , 59 , 61 , 62 , 65 – 67 , 69 – 71 , 74 – 81 , 83 – 85 , 87 , 89 , 91 , 97 , 99 , 100 – 103 , 105 – 108 , 111 – 113 , 115 – 121 , 124 – 126 , 128 – 135 , 139 , 140 The patients’ mean age was 45 years (range, 3 mo to 85 yr). Fifty-four patients were male and 41 female (sex was not reported in 2 cases).…”

Fungal Infections Complicating Lung Transplantation

“…335 In one study of 233 cases of fusariosis, 114 (49%) had lung involvement; 109 with lung involvement had disseminated disease (96%). 335 Radiographic features of pulmonary fusariosis are varied and include cavities, 328 halo signs, 335 multiple nodules, 334,337,357 and consolidation; 334 infection of the bronchial anastomotic site was documented in a LTR. 327 Dissemination or invasive disease in immunocompromised hosts has been associated with high mortality rates (60-100%).…”

Fusariosis

“…In addition, various infections caused by Fusarium species in immunocompetent patients have been reported, including combat-related injuries, 14 peritonitis in patients receiving peritoneal dialysis, 15,16 thrombophlebitis, 17 arthritis, 18,19 osteomyelitis, [20][21][22][23] endophtalmitis, 24 fungemia, [25][26][27] sinusitis, [28][29][30][31] and pneumonia. [32][33][34] Fusariosis in immunocompromised patients is almost always an invasive and frequently disseminated disease. The typical clinical presentation is fever in a severely neutropenic patient who presents with myalgia and the sudden appearance of erythematous papular or nodular painful skin lesions (►Fig.…”

“…The clinical spectrum of lung disease associated with Fusarium species is similar to that caused by Aspergillus species and includes allergic disease (allergic bronchopulmonary fusariosis), 59 hypersensitivity pneumonitis, 29 colonization of a pre-existing cavity, 60 localized pneumonia in immunocompetent individuals, 61 and pneumonia in severely immunocompromised patients. 3,8 We did a literature review of 294 cases of fusariosis, 3 and updated with 63 additional cases in immunocompetent 19,25,27,[61][62][63][64][65][66][67] and immunocompromised patients 31,34,39,43,44,47,48,50, published between 2005 and 2014. Pneumonia caused by Fusarium species was reported in 152 cases (42%), occurring in 145 of 317 (46%) immunocompromised patients and in seven of 40 (17.5%) immunocompetent patients (p < 0.001).…”