Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6443-6449
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6443
Disseminated infection by Fusarium solani in acute lymphocytic leukemia: A case report
Yu-Fang Yao, Jia Feng, Jie Liu, Chao-Feng Chen, Bo Yu, Xiao-Ping Hu
Yu-Fang Yao, Jie Liu, Chao-Feng Chen, Bo Yu, Xiao-Ping Hu, Department of Dermatology & Venereology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
Jia Feng, Department of Hematology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
Author contributions: Yao YF and Feng J contributed equally to this work and should be considered joint first authors; Hu XP reviewed the data and coordinated the authors; Yao YF and Feng J wrote the paper and extracted the data; Liu J, Chen CF, and Yu B revised the edited the article.
Supported by the Scientific Research Project of Peking University Shenzhen Hospital, No. JCYJ2018011; and the San-Ming Project of Medicine in Shenzhen, No. SZSM201812059.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Xiao-Ping Hu, PhD, Associate Professor, Department of Dermatology & Venereology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Futian District, Shenzhen 518036, Guangdong Province, China. xiaoping7752@sohu.com
Received: March 9, 2021
Peer-review started: March 9, 2021
First decision: April 24, 2021
Revised: May 7, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: August 6, 2021
Abstract
BACKGROUND

In recent years, the rate of immunosuppressed patients has increased rapidly. Invasive fungal infections usually occur in these patients, especially those who have had hematological malignances and received chemotherapy. Fusariosis is a rare pathogenic fungus, it can lead to severely invasive Fusarium infections. Along with the increased rate of immune compromised patients, the incidence of invasive Fusarium infections has also increased from the past few years. Early diagnosis and therapy are important to prevent further development to a more aggressive or disseminated infection.

CASE SUMMARY

We report a case of a 19-year-old male acute B-lymphocytic leukemia patient with fungal infection in the skin, eyeball, and knee joint during the course of chemotherapy. We performed skin biopsy, microbial cultivation, and molecular biological identification, and the pathogenic fungus was finally confirmed to be Fusarium solani. The patient was treated with oral 200 mg voriconazole twice daily intravenous administration of 100 mg liposomal amphotericin B once daily, and surgical debridement. Granulocyte colony-stimulating factor was administered to expedite neutrophil recovery. The disseminated Fusarium solani infection eventually resolved, and there was no recurrence at the 3 mo follow-up.

CONCLUSION

Our case illustrates the early detection and successful intervention of a systemic invasive Fusarium infection. These are important to prevent progression to a more aggressive infection. Disseminate Fusarium infection requires the systemic use of antifungal agents and immunotherapy. Localized infection likely benefits from surgical debridement and the use of topical antifungal agents.

Keywords: Acute lymphocytic leukemia, Invasive fungal infection, Fusarium sp., Neutropenia, Skin lesions, Case report

Core Tip: Fusarium as a rare pathogenic fungus can lead to severely invasive fusariosis and is associated with high morbidity and with up to 70% mortality. The clinical manifestations of invasive Fusarium infection are varied; early diagnosis and proper therapies are essential. In such infections, the identification of fungal etiology is very important. Histopathological examination, microbial cultivation, antifungal susceptibility testing, and molecular biological identification are helpful for the diagnosis and treatment of this disease. In this case, the diagnosis was clear and the patient was successfully treated with positive efforts.