Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 6049-6055
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6049
Disseminated Fusarium bloodstream infection in a child with acute myeloid leukemia: A case report
Jun-Jie Ning, Xue-Mei Li, Sheng-Qiu Li
Jun-Jie Ning, Xue-Mei Li, Sheng-Qiu Li, Department of PICU, First People's Hospital of Zigong City, Zigong 643000, Sichuan Province, China
Author contributions: Ning JJ was the patient’s doctor, reviewed the literature, and contributed to drafting the manuscript; Li XM provided the plans for the treatment; Li SQ was the nurse in charge of the child and provided skin pictures of various periods; all authors issued final approval of the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this manuscript and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Jun-Jie Ning, MD, Doctor, Department of PICU, First People's Hospital of Zigong City, No. 42 Yizhi Road, Shangyihao, Zigong 643000, Sichuan Province, China. nestlord@foxmail.com
Received: February 22, 2021
Peer-review started: March 2, 2021
First decision: March 25, 2021
Revised: April 6, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: July 26, 2021
Processing time: 148 Days and 19.4 Hours
Abstract
BACKGROUND

Disseminated Fusarium is rare in healthy children. Children with hematological tumors may have secondary fungal infections, including Fusarium infections, which are due to tumor bone marrow infiltration or prolonged bone marrow suppression after chemotherapy. Because of the lack of typical clinical manifestations and effective antifungal drugs, early diagnosis and treatment of the disease are difficult, and the prognosis is poor.

CASE SUMMARY

The patient in this case was a 13-year-old female child with rash and fever as the first symptoms. She had the characteristics of the four stages of skin that are typical of Fusarium infection. She was diagnosed with disseminated Fusarium infection through skin biopsy and blood culture and diagnosed with Fusarium solani infection based on the morphological characteristics of the blood culture. After treatment with liposome amphotericin B combined with voriconazole, the child recovered.

CONCLUSION

This case highlights that for children with secondary agranulocytosis after receiving chemotherapy for hematological malignancies, once typical abnormal skin damage is found, the possibility of Fusarium infection should be considered, and voriconazole alone or in combination with polyenes may be the most effective anti-Fusarium drugs. Amphotericin B, the traditional drug of disseminated Fusarium disease, has a high mortality rate, and it is not recommended to use it alone. Adequate neutrophil counts are essential for the treatment of disseminated Fusarium bloodstream infection.

Keywords: Fusarium; Liposomal amphotericin B; Voriconazole; Acute myeloid leukemia; Agranulocytosis; Case report

Core Tip: We present herein the case of a Fusarium infection female child with rash and fever as the first symptoms. She had the characteristics of the four stages of skin typical of Fusarium infection. She was diagnosed with disseminated Fusarium infection through blood culture. For children with secondary agranulocytosis after receiving chemotherapy for hematological malignancies, once typical abnormal skin damage is found, the possibility of Fusarium infection should be considered, and the key to treatment is early diagnosis, the reversal of immunosuppression, and the provision of the correct antifungal treatment as soon as possible.