Introduction. Infections caused by fungi of Fusarium species occur in
immunocompromised individuals as disseminated diseases. Case Report. This
case report presents a 5-year-old boy with acute lymphoblastic leukemia who
developed a disseminated fusarium infection during reinduction
chemotherapy. Fever was the main symptom and it lasted for 15 weeks.
Refractory fever despite broad-spectrum antibiotics, as well as nausea,
myalgia, pulmonary symptoms with detection of pulmonary infiltrates, liver
and spleen involvement indicated an invasive fungal infection. The patient
received fluconazole, voriconazole, liposomal amphotericin B and
caspofungin. Since high temperature was persistent, diagnostic laparoscopy
of the abdomen was done. Scattered lesions, up to 2 mm in diameter, were
observed macroscopically on the surface of the liver and spleen. The liver
culture was positive for Acinetobacter and Fusarium species. After 38 days
of therapy with liposomal amphotericin B and 3 days of ciprofloxacin, the
patient became afebrile. Itraconazole (according to the antimycogram) was
continued during maintenance therapy. Abdominal ultrasound was completely
normal after 5 months of treatment with itraconazole. This boy was our first
patient with a disseminated fusarium infection. At that time, Fusarium was
detected in the hospital water system and in hospital air samples.
Conclusion. A timely diagnosis of invasive fungal diseases in children is a
big challenge. Over the past decade, there has been an increase in survival
rate of patients with invasive fusariosis due to much more common use of
voriconazole or combined antifungal therapy.
Disseminated fusariosis in a pediatric patient with acute lymphoblastic leukemia and prolonged fever - a case report
