Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report
BackgroundInvasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While Aspergillus species are recognized as predominant pathogens, Fusarium species should also be considered due to their broad environmental distribut...
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| Format: | Article |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.1060663/full |
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| author | Maurice Hannemann Dunja Wilmes Frank Dombrowski Jürgen Löffler Alexander Kaminski Astrid Hummel Lena Ulm Jürgen Bohnert Volker Rickerts Jan Springer Holger N. Lode Karoline Ehlert |
| author_facet | Maurice Hannemann Dunja Wilmes Frank Dombrowski Jürgen Löffler Alexander Kaminski Astrid Hummel Lena Ulm Jürgen Bohnert Volker Rickerts Jan Springer Holger N. Lode Karoline Ehlert |
| author_sort | Maurice Hannemann |
| collection | DOAJ |
| description | BackgroundInvasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While Aspergillus species are recognized as predominant pathogens, Fusarium species should also be considered due to their broad environmental distribution and the expected poor outcome of invasive fusariosis. Particularly, splenic rupture as a complication of disseminated disease has not been reported yet.Case presentationTwo weeks after allogeneic HSCT for severe aplastic anemia, a 16-year-old boy presented with painful, erythematous skin nodules affecting the entire integument. As disseminated mycosis was considered, treatment with liposomal amphotericin B and voriconazole (VCZ) was initiated. Invasive fusariosis was diagnosed after histological and previously unpublished polymerase chain reaction-based examination of skin biopsies. Microbiological tests revealed Fusarium solani species. Despite stable neutrophil engraftment and uninterrupted treatment with VCZ, he developed mold disease-associated splenic rupture with hypovolemic shock and fungal endocarditis. The latter induced a cardiac thrombus and subsequent embolic cerebral infarctions with unilateral hemiparesis. Following cardiac surgery, the patient did not regain consciousness because of diffuse cerebral ischemia, and he died on day +92 after HSCT.ConclusionInvasive fusariosis in immunocompromised patients is a life-threatening condition. Despite antimycotic treatment adapted to antifungal susceptibility testing, the patient reported here developed uncommon manifestations such as splenic rupture and fungal endocarditis. |
| first_indexed | 2024-04-12T06:01:19Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T06:01:19Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-243edd6f00f1449c8988bf9dc37631d22022-12-22T03:45:01ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-12-011010.3389/fped.2022.10606631060663Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case reportMaurice Hannemann0Dunja Wilmes1Frank Dombrowski2Jürgen Löffler3Alexander Kaminski4Astrid Hummel5Lena Ulm6Jürgen Bohnert7Volker Rickerts8Jan Springer9Holger N. Lode10Karoline Ehlert11Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, GermanyDivision for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, GermanyInstitute of Pathology, University Medicine Greifswald, Greifswald, GermanyDepartment of Internal Medicine II, University Hospital Würzburg, Würzburg, GermanyDepartment for Heart and Vascular Surgery, Klinikum Karlsburg, Karlsburg, GermanyDepartment of Internal Medicine B, University Medicine Greifswald, Greifswald, GermanyInstitute of Microbiology, University Medicine Greifswald, Greifswald, GermanyInstitute of Microbiology, University Medicine Greifswald, Greifswald, GermanyDivision for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, GermanyDepartment of Internal Medicine II, University Hospital Würzburg, Würzburg, GermanyDepartment of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, GermanyDepartment of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, GermanyBackgroundInvasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While Aspergillus species are recognized as predominant pathogens, Fusarium species should also be considered due to their broad environmental distribution and the expected poor outcome of invasive fusariosis. Particularly, splenic rupture as a complication of disseminated disease has not been reported yet.Case presentationTwo weeks after allogeneic HSCT for severe aplastic anemia, a 16-year-old boy presented with painful, erythematous skin nodules affecting the entire integument. As disseminated mycosis was considered, treatment with liposomal amphotericin B and voriconazole (VCZ) was initiated. Invasive fusariosis was diagnosed after histological and previously unpublished polymerase chain reaction-based examination of skin biopsies. Microbiological tests revealed Fusarium solani species. Despite stable neutrophil engraftment and uninterrupted treatment with VCZ, he developed mold disease-associated splenic rupture with hypovolemic shock and fungal endocarditis. The latter induced a cardiac thrombus and subsequent embolic cerebral infarctions with unilateral hemiparesis. Following cardiac surgery, the patient did not regain consciousness because of diffuse cerebral ischemia, and he died on day +92 after HSCT.ConclusionInvasive fusariosis in immunocompromised patients is a life-threatening condition. Despite antimycotic treatment adapted to antifungal susceptibility testing, the patient reported here developed uncommon manifestations such as splenic rupture and fungal endocarditis.https://www.frontiersin.org/articles/10.3389/fped.2022.1060663/fullinvasive mold infectionfusariumendocarditissplenic rupturehematopoietic stem cell transplantationcase report |
| spellingShingle | Maurice Hannemann Dunja Wilmes Frank Dombrowski Jürgen Löffler Alexander Kaminski Astrid Hummel Lena Ulm Jürgen Bohnert Volker Rickerts Jan Springer Holger N. Lode Karoline Ehlert Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report Frontiers in Pediatrics invasive mold infection fusarium endocarditis splenic rupture hematopoietic stem cell transplantation case report |
| title | Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report |
| title_full | Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report |
| title_fullStr | Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report |
| title_full_unstemmed | Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report |
| title_short | Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report |
| title_sort | splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia a case report |
| topic | invasive mold infection fusarium endocarditis splenic rupture hematopoietic stem cell transplantation case report |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.1060663/full |
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