Septic arthritis as breakthrough invasive fusariosis after cord blood transplantation

IF 0.7 Q4 HEMATOLOGY Leukemia Research Reports Pub Date : 2024-01-01 DOI:10.1016/j.lrr.2024.100483

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

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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.

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脐带血移植后作为突破性侵袭性镰刀菌病的化脓性关节炎

一名 63 岁的男性因急性髓性白血病复发接受了第三次异基因造血干细胞移植，并使用了伏立康唑预防疗法。第 42 天，他因真菌感染出现了化脓性关节炎，但没有任何典型的皮肤损害。手术清创后，他开始接受脂质体两性霉素 B 治疗，但最终死于进行性真菌感染。核糖体 DNA 测序发现茄属镰刀菌种复合体（FSSC）对伏立康唑产生抗药性。这一临床病程表明，当血液恶性肿瘤患者在服用伏立康唑预防期间出现化脓性关节炎而无典型皮损时，突破性侵袭性镰刀菌病（耐唑类药物的 FSSC 感染）需要作为病原体加以考虑。

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