Short report

Fatal disseminated fusarium infection in acute lymphoblastic leukaemia in complete remission

B Austen¹, H McCarthy¹, B Wilkins², A Smith¹ and A Duncombe¹

¹ Department of Haematology, Southampton General Hospital, Tremona Road, Southampton S016 6YD, UK
² Department of Histopathology, Southampton General Hospital

Correspondence to:
Dr Austen, 56 Lyric Way, Thornhill, Cardiff CF14 9BP, UK Belindadoc{at}aol.com

Fusarium species are increasingly recognised as serious pathogens in the immunocompromised. The outcome in the context of persistent severe neutropenia has been almost universally fatal. However, there have been several case reports of successful treatment if neutrophil recovery can be achieved. This report presents the case of a fatality that occurred despite neutrophil recovery. A 67 year old man developed disseminated fusariosis during the neutropenic phase of induction chemotherapy for acute lymphoblastic leukaemia. Fusarium dimerum was isolated from blood cultures. This species is highly unusual and very few case reports exist in the literature. An initial response to amphotericin treatment coincided with neutrophil recovery but a subsequent relapse occurred, despite adequate neutrophil counts, which proved fatal. It is postulated that reseeding of the blood from an occult site, namely the right vitreum in this case, led to this secondary relapse despite achieving complete leukaemic remission.

Key Words: fusarium • disseminated • neutropenia • remission

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Azor, M., Gene, J., Cano, J., Manikandan, P., Venkatapathy, N., Guarro, J. (2009). Less-Frequent Fusarium Species of Clinical Interest: Correlation between Morphological and Molecular Identification and Antifungal Susceptibility. J. Clin. Microbiol. 47: 1463-1468 [Abstract] [Full Text]  
• Su, C.-C., Hsu, H.-J., Wu, J.-J., Chou, C.-W. (2007). Diagnosis of fusariosis in urine cytology. J. Clin. Pathol. 60: 422-424 [Abstract] [Full Text]  
• Letscher-Bru, V., Campos, F., Waller, J., Randriamahazaka, R., Candolfi, E., Herbrecht, R. (2002). Successful Outcome of Treatment of a Disseminated Infection Due to Fusarium dimerum in a Leukemia Patient. J. Clin. Microbiol. 40: 1100-1102 [Abstract] [Full Text]