Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2374-2383
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2374
Treatment of invasive fungal disease: A case report
Xue-Fei Xiao, Jiong-Xing Wu, Yang-Cheng Xu
Xue-Fei Xiao, Jiong-Xing Wu, Department of Emergency and Intensive Medicine, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Yang-Cheng Xu, Department of Burn Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Author contributions: All authors contributed equally to this work; Xiao XF designed the research; Wu JX analyzed the data; Xu YC collected the data; Xiao XF, Wu JX and Xu YC wrote the paper.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xue-Fei Xiao, MD, PhD, Associate Professor, Doctor, Department of Emergency and intensive Medicine, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha 410013, Hunan Province, China. xiaoxuefei@csu.edu.cn
Telephone: +86-731-88921910 Fax: +86-731-88921910
Received: January 22, 2019
Peer-review started: January 23, 2019
First decision: March 18, 2019
Revised: May 17, 2019
Accepted: June 26, 2019
Article in press: June 27, 2019
Published online: August 26, 2019
Processing time: 216 Days and 21.3 Hours
Abstract
BACKGROUND

In recent years, the incidence of fungal infection has been increasing, often invading one or more systems of the body. However, it is rare for lymph nodes to be invaded without the involvement of other organs.

CASE SUMMARY

A 21-year-old man was admitted to hospital for repeated cough for 2 mo and abdominal pain for 1 mo. Physical examination revealed multiple lymph nodes enlargement, especially those in the left neck and groin. CT scan showed multiple lymph nodes enlargement in the chest, especially left lung, abdominal cavity, and retroperitoneum. The first lymph node biopsy revealed granulomatous lesions of lymph nodes, so intravenous infusion of Cefoperazone tazobactam combined with anti-tuberculosis drugs were given. Because fever and respiratory failure occurred 4 d after admission, mechanical ventilation was given, and Caspofungin and Voriconazole were used successively. However, the disease still could not be controlled. On the 11th day of admission, the body temperature reached 40° C. After mycosis of lymph nodes was confirmed by the second lymph node biopsy, Amphotericin B was given, and the patient recovered and was discharged from the hospital.

CONCLUSION

No fixed target organ was identified in this case, and only lymph node involvement was found. Caspofungin, a new antifungal drug, and the conventional first choice drug, Voriconazole, were ineffective, while Amphotericin B was effective.

Keywords: Invasive fungal disease; Case report; Lymphadenectasis; Lymph node biopsy; Mycosis of lymph nodes; Amphotericin B

Core tip: In this case, the results from cervical and supraclavicular lymph node biopsies were different. It is very difficult to diagnose lymph node mycosis quickly in the early stage. When conventional anti-infective treatment is ineffective, multi-stage and multi-site lymph node biopsy is particularly important. The new antifungal drug Caspofungin and the empirical antifungal agent Voriconazole were ineffective, and successful treatment was achieved with Amphotericin B.