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03 September 2015 : Case report  

Atypical Clinical Presentation of a Newer Generation Anti-Fungal Drug-Resistant Fusarium Infection After a Modified Multi-Visceral Transplant

Ahmed KandeelABCDEF, Kareem Abu-ElmagdA, Michael SpinnerADE, Ajai KhannaA, Koji HashimotoA, Masato FujikiA, Mansiur ParsiA, Ana BennettBE, Galal El-GazzazB, Ahmed Abd-ElaalB

DOI: 10.12659/AOT.892209

Ann Transplant 2015; 20:512-518

Abstract

BACKGROUND: Fusarium spp. infections have become an emerging and lethal threat to the immunocompromised patient population, especially those with neutropenia. Recently there have been increased reports in solid organ transplant recipients. Presentation is commonly as soft tissue infections several months post-transplant. With high morbidity and mortality, efficacious antifungal therapy is essential. This remains challenging with limited data and no established clinical breakpoints defined.

CASE REPORT: We report on a modified multi-visceral transplant patient that developed a Fusarium infection only 7 weeks post-transplant in the native hard palate and esophagus, without any soft tissue lesions, which persisted despite aggressive combination treatment with amphotericin B lipid complex and voriconazole.

CONCLUSIONS: Fusarium spp. infection in solid organ transplant is a significant challenge without clear diagnostic clinical indicators of infection, or specific time of onset, in addition to possible emergence of a more aggressive drug-resistant strain.

Keywords: Drug Resistance, Fungal, Fusarium, Organ Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358