Disseminated Fusariosis with Secondary Hemophagocytic Lymphohistiocytosis

Disseminated Fusariosis with Secondary Hemophagocytic Lymphohistiocytosis

We report here a 7-year girl with B-Acute Lymphoblastic Leukemia (ALL) on Berlin Frankfurt Munster (BFM) based induction chemotherapy who presented with fever, cough, and painful necrotic skin lesions simulating pseudomonas sepsis. The patient was eventually diagnosed with disseminated fusariosis. While on combination antifungal therapy, fever reappeared with pancytopenia and hepatosplenomegaly, and she was subsequently diagnosed with secondary Hemophagocytic lymphohistiocytosis (HLH) and was treated using the HLH 2004 protocol. The child responded to treatment well. This report highlights the high index of clinical suspicion, appropriate investigations needed to diagnose fusariosis and secondary HLH in pediatric oncology practice promptly, and the successful treatment outcome despite having them both.

___

  • 1. Boutati EI, Anaissie EJ. Fusarium-A Significant Emerging Pathogen in Patients With Hematologic Malignancy: Ten Years’ Experience at a Cancer Center and Implications for Management. Blood 1997; 90:999–1008.
  • 2. Castagnola E, Cesaro S, Giacchino M, et al. Fungal infections in children with cancer: a prospective, multicenter surveillance study. Pediatr Infect Dis J 2006; 25:634–639.
  • 3. Nucci M, Marr KA, Queiroz-Telles F, et al. Fusarium infection in hematopoietic stem cell transplant recipients. Clin Infect Dis 2004; 38:1237–1242.
  • 4. Nucci M, Anaissie EJ, Queiroz-Telles F, et al. Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection. Cancer 2003; 98:315–319.
  • 5. Mikami R, Stemmermann GN. Keratomycosis Caused by Fusarium oxysporum. Am J Clin Pathol 1958; 29:257–262.
  • 6. Liu YS, Wang NC, Ye RH, e al. Disseminated Fusarium infection in a patient with acute lymphoblastic leukemia: A case report and review of the literature. Oncol Lett 2014; 7:334–336.
  • 7. Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin Infect Dis 2002; 35:909–920.
  • 8. Bodey GP, Boktour M, Mays S, et al. Skin lesions associated with Fusarium infection. J Am Acad Dermatol 2002; 47:659–666.
  • 9. McCarthy MW, Katragkou A, Iosifidis E, et al. Recent Advances in the Treatment of Scedosporiosis and Fusariosis. J Fungi (Basel, Switzerland) 2018;4(2).
  • 10. Stempel JM, Hammond SP, Sutton DA, et al. Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience. Open Forum Infect Dis, 2015; 2(3):ofv099.
  • 11. Nucci M, Marr KA, Vehreschild MJ, et al. Improvement in the outcome of invasive fusariosis in the last decade. Clin Microbiol Infect 2014; 20:580–585.
  • 12. Horn DL, Freifeld AG, Schuster MG, et al. Treatment and outcomes of invasive fusariosis: review of 65 cases from the PATH Alliance(®) registry. Mycoses 14; 57:652–658.
  • 13. Tortorano AM, Richardson M, Roilides E, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others.Clin Microbiol Infect 2014; 20(3):27–46.
  • 14. Rouphael NG, Talati NJ, Vaughan C, et al.Infections associated with haemophagocytic syndrome. Lancet Infect Dis 2007; 7:814–822.
  • 15. Albisetti M, Lauener RP, Gungor T, et al. Disseminated Fusarium oxysporum infection in hemophagocytic lymphohistiocytosis. Infection 2004; 32:364–366.
  • 16. Karlsson T. Secondary haemophagocytic lymphohistiocytosis: Experience from the Uppsala University Hospital. Ups J Med Sci 2015; 120:257.