Disseminated Fusariosis- A NEJM case report
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Fusariosis is an emerging infectious disease in immunocompromised patients that may present as a localized skin infection, mycetoma, or pneumonia. Localized and disseminated infections have been reported in patients with hematologic malignancies, burns, transplants, and aplastic anemia. Disseminated fusariosis is most commonly linked to prolonged neutropenia.

An 8-year-old boy presented with subcutaneous nodules associated with a 1-week history of fever 2 months after starting treatment for relapsing B-cell leukemia. He had had pancytopenia for 57 days, and laboratory studies showed a hemoglobin level of 7.5 g per deciliter, a white-cell count of 200 per cubic millimeter, and a platelet count of 12,000 per cubic millimeter. Fevers persisted despite the initiation of broad spectrum intravenous antibiotic and antifungal treatment, and 1 week later, the subcutaneous nodules developed.

Physical examination revealed nodules ranging from 5 to 18 mm in diameter on the chest, back, arms, and legs. A biopsy specimen of a nodule was obtained. Microscopic examination of a dry smear stained with lactophenol cotton blue revealed septated hyphae and spores, and Fusarium dimerum was grown in culture. Gram’s staining of a blood culture revealed hyphae and spores, and cultures also revealed F. dimerum. The patient completed a prolonged course of treatment with antifungal therapy. His fever resolved within 11 days, and the skin lesions resolved within 20 days.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1911084
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