SESSION TITLE: Infectious Disease Cases II
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Wednesday, October 29, 2014 at 11:00 AM - 12:15 PM
INTRODUCTION: Infectious Infectious complications are common after organ trans- plantation because of the profound immunosuppressed status. The incidence of invasive mycoses is 5% to 42%, depending on type of organ transplanted. Here we present a case of invasive and rapidly progressive scedopsirum infection in a lung transplant patient.
CASE PRESENTATION: A 53-year-old man underwent bilateral lung transplantation for scleroderma 8 years prior to admission. He was admitted with a 2-week history of cellulitis of the leg and a small bowel obstruction which was surgically corrected. Arthrocentesis performed for knee swelling showed gouty crystals and was treated with a steroid injection. The patient initially improved on antibiotic therapy but on hospital day 12 developed a complete bowel obstruction. He underwent a hemicolectomy; intraoperative cultures revealed Pseudomonas and Enterococcus. The patient deteriorated and developed a diffuse blistering, desquamating rash. Punch biopsy revealed hyphal forms. Voriconacole, amphotericin, and micafungin were initiated. He developed multiorgan failure and died one month after admission. Postmortem examination revealed ubiquitous infiltration of Scedosporum prolificans. Autopsy revealed exuberant conidial and hyphal forms in the skin, lung, heart, liver, gallbladder, and small intestine. While morphologically similar to Aspergillus, Scedosporium features conidial forms which allow invasive hematogenous spread to distant organs.
DISCUSSION: Unlike the other pathogen in the genus, S. apiospermum, S. prolificans is largely resistant to all conventional agents. First identified in 1984, S prolificans has been increasingly recognized as an opportunistic pathogen. The most common site of infection is via skin defects or the lung. S. prolificans proclivity towards rapid dissemination, frequent confusion with Aspergillus, and resistance to treatment contribute to high mortality in the immunocompromised patient. Given its lethality and increasing prevalence, the identification of mold with signs of dissemination should prompt early consideration of Scedosporium.
CONCLUSIONS: Early and accurate diagnosis is essential because these fungi can be confused with amphotericin-sensitive molds, especially Aspergillus spp. Due to limited treatment options, mortality is as high as 95% and should be managed agressively.
Reference #1: Pulmonary scedosporium infection following lung transplantation.Tamm M, Malouf M, Glanville A. Transpl Infect Dis. 2001 Dec;3(4):189-94.
DISCLOSURE: The following authors have nothing to disclose: Muhammad Rashad, Mark Valdez, Linh Turong, Aarti Chawla, Ganesh Sivagini
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