Disseminated Fusariosis with Secondary Hemophagocytic Lymphohistiocytosis

Abstract

We report here a 7-year girl with B-Acute Lymphoblastic Leukemia (ALL) on Berlin Frankfurt Munster (BFM) based induction chemotherapy who presented with fever, cough, and painful necrotic skin lesions simulating pseudomonas sepsis. The patient was eventually diagnosed with disseminated fusariosis. While on combination antifungal therapy, fever reappeared with pancytopenia and hepatosplenomegaly, and she was subsequently diagnosed with secondary Hemophagocytic lymphohistiocytosis (HLH) and was treated using the HLH 2004 protocol. The child responded to treatment well. This report highlights the high index of clinical suspicion, appropriate investigations needed to diagnose fusariosis and secondary HLH in pediatric oncology practice promptly, and the successful treatment outcome despite having them both.