Title : A case report of fusariosis in a filipino patient with a solid tumor
Abstract:
Background:
Fusarium spp. are fungal species usually found in soil, water, and plants, which can cause infection, especially in immunocompromised patients. Fusarium infections are commonly seen in hematologic neoplasms; only a few are reported in solid organ malignancies.
Case Description:
We report a 59-year-old Filipino female who lives in a subdivision who complained of intermittent abdominal pain, jaundice, pruritus, and vomiting for one month, prompting a consult. A whole abdominal ultrasound showed the presence of choledocholithiasis. Further evaluation with an entire abdominal contrast-enhanced computed tomographic [CT] scan showed choledocholithiasis causing obstructive intra- and extra-hepatic duct dilatation; hence, she initially received management for obstructive jaundice secondary to choledocholithiasis. The healthcare team inserted a percutaneous transhepatic left internal biliary drainage catheter and performed a laparoscopic gastrojejunostomy. Histopathology of the duodenum revealed a metastatic adenocarcinoma. On day two, postoperatively, the patient developed a high-grade fever; she underwent a septic workup. Blood culture grew Fusarium spp., sensitive to amphotericin B and voriconazole.
The patient received voriconazole, which resolved her fever. We discharged the patient after a repeat blood culture on day 3 of treatment was negative. We continued voriconazole and advised close follow-up for monitoring of her condition. Upon discharge, the patient had been compliant with the regimen. However, family members noted that she had poor appetite and progressive generalized body weakness by week 3 of treatment. The patient deteriorated, but the family deferred further evaluation upon the patient's request. She eventually expired by week 5 of treatment.
Discussion:
Fusariosis is a relatively rare opportunistic infection. Although invasive fusariosis is uncommon, the prognosis is poor, with a mortality rate ranging from 50% to 80%. Many cases are found in patients with hematologic malignancies. Fusarium spp. isolate in cultures is the diagnostic gold standard. Invasive fusariosis may occur in patients with solid organ malignancies. Given this, a high index of suspicion for fusariosis among those with solid neoplasms is essential because delay in diagnosis and treatment can result in catastrophic consequences.
Audience Take Away:
- Early recognition of this disease can avoid delay in management.
- This scenario will help other doctors understand that this type of disease can occur even in patients with solid tumor and possibly manage it in more effective manner
