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Hannemann, Maurice; Wilmes, Dunja; Dombrowski, Frank; Löffler, Jürgen; Kaminski, Alexander; Hummel, Astrid; Ulm, Lena; Bohnert, Jürgen; Rickerts, Volker; Springer, Jan; Lode, Holger N.; Ehlert, Karoline

Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report

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  • Media type: E-Article
  • 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
  • Contributor: Hannemann, Maurice; Wilmes, Dunja; Dombrowski, Frank; Löffler, Jürgen; Kaminski, Alexander; Hummel, Astrid; Ulm, Lena; Bohnert, Jürgen; Rickerts, Volker; Springer, Jan; Lode, Holger N.; Ehlert, Karoline
  • imprint: Frontiers Media SA, 2022
  • Published in: Frontiers in Pediatrics
  • Language: Not determined
  • DOI: 10.3389/fped.2022.1060663
  • ISSN: 2296-2360
  • Keywords: Pediatrics, Perinatology and Child Health
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Background</jats:title><jats:p>Invasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While <jats:italic>Aspergillus</jats:italic> species are recognized as predominant pathogens, <jats:italic>Fusarium</jats:italic> 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.</jats:p></jats:sec><jats:sec><jats:title>Case presentation</jats:title><jats:p>Two 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 Invasive fusariosis was diagnosed after histological and previously unpublished polymerase chain reaction-based examination of skin biopsies.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 <jats:italic>Fusarium solani</jats:italic> 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Invasive 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.</jats:p></jats:sec>
  • Access State: Open Access