Septic arthritis as breakthrough invasive fusariosis after cord blood transplantation

Shinichi Katsuoka; Hidehiro Itonaga; Yasushi Sawayama; Masahiko Chiwata; Haruka Watanabe; Yuichi Yamada; Machiko Fujioka; Takeharu Kato; Shinya Sato; Koji Ando; Masato Tashiro; Takahiro Takazono; Yoshitaka Imaizumi; Koichi Izumikawa; Katsunori Yanagihara; Hiroshi Mukae; Yasushi Miyazaki

doi:10.1016/j.lrr.2024.100483

Septic arthritis as breakthrough invasive fusariosis after cord blood transplantation

Leuk Res Rep. 2024 Sep 24:22:100483. doi: 10.1016/j.lrr.2024.100483. eCollection 2024.

Authors

Shinichi Katsuoka^{1

2}, Hidehiro Itonaga³, Yasushi Sawayama⁴, Masahiko Chiwata⁵, Haruka Watanabe⁶, Yuichi Yamada^{1

2}, Machiko Fujioka^{2

7}, Takeharu Kato¹, Shinya Sato¹, Koji Ando¹, Masato Tashiro⁸, Takahiro Takazono^{8

9}, Yoshitaka Imaizumi⁶, Koichi Izumikawa⁸, Katsunori Yanagihara¹⁰, Hiroshi Mukae⁹, Yasushi Miyazaki^{1

2

11}

Affiliations

¹ Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.
² Department of Hematology, Nagasaki University Graduate School of Biomedical Sciences, Japan.
³ Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan.
⁴ Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.
⁵ Department of Hematology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan.
⁶ Department of Hematology, National Hospital Organization Nagasaki Medical Center, Ohmura, Japan.
⁷ Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
⁸ Department of Infectious Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
⁹ Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
¹⁰ Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
¹¹ Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.

Abstract

A 63-year-old male received a third allogeneic hematopoietic stem cell transplantation with voriconazole prophylaxis for relapsed acute myeloid leukemia. He developed septic arthritis without any typical skin lesions due to fungal infection on day 42. Treatment with liposomal amphotericin B was initiated following surgical debridement; however, he died of progressive fungal infection. Ribosomal DNA sequencing identified Fusarium solani species complex (FSSC) harboring voriconazole resistance. This clinical course indicates that breakthrough invasive fusariosis (azole-resistant FSSC infection) needs to be considered as a pathogen when patients with hematological malignancies develop septic arthritis without typical skin lesions during voriconazole prophylaxis.

Keywords: Allogeneic stem cell transplantation; Azole-resistant; Invasive fusariosis; Septic arthritis.

Publication types

Case Reports