Disseminated fusariosis and endogenous fungal endophthalmitis in acute lymphoblastic leukemia following platelet transfusion possibly due to transfusion-related immunomodulation

Abstract

BackgroundTo report a case of disseminated fusariosis with endogenous endophthalmitis in a patient with acute lymphoblastic leukemia. Transfusion-associated immune modulation secondary to platelet transfusion could play an important role in the pathophysiology of this case.Case PresentationA 9 year-old male with acute lymphoblastic leukemia complicated by pancytopenia and disseminated Intravascular coagulation was given platelet transfusion. He developed disseminated fusariosis and was referred to the ophthalmology team for right endogenous endophthalmitis. The infection was controlled with aggressive systemic and intravitreal antifungals.ConclusionPatients with acute lymphoblastic leukemia are predisposed to endogenous fungal endophthalmitis. Transfusion-associated immune modulation may further increase host susceptibility to such opportunistic infections.

Successful treatment of bilateral endogenous Fusarium solani endophthalmitis in a patient with acute lymphocytic leukaemia

“…in immunocompromised or neutropenic patients. Fourteen cases were previously reported in more recent literature (from 2002 to present): twelve in haematology patients (six acute myeloid leukaemia or myelodysplastic syndrome, five acute lymphoblastic leukaemia, one Hodgkin lymphoma), one liver transplant and one patient affected by diabetes mellitus (Table ) . In the fourteen cases, the infection was limited to the eye in three patients including the eyelids and skin surrounding the eyes, while it was disseminated (with eye involvement) in the remaining 11 cases: skin (10 cases), blood (7 cases), lungs (4 cases), CNS (2 cases) and bone (1 case).…”

“…3,6,[22][23][24] Although less common, disseminated infections involving the eye, joints, CNS and heart valves have been reported. [15][16][17][18][19]25 The largest contemporary series of Fusarium endophthalmitis outcomes was reported by Troke et al, (n = 24) who found a 63% overall response rate when patient received treatment with systemic and topical voriconazole with or without vitrectomy. 26 However, this case series described patients with mostly exogenous infections and did (Table 1).…”

“…26 However, this case series described patients with mostly exogenous infections and did (Table 1). [15][16][17][18][19][20][21]25 In the fourteen cases, the infection was limited to the eye in three patients including the eyelids and skin surrounding the eyes, while it was disseminated (with eye involvement) in the remaining 11 cases: skin (10 cases), blood (7 cases), lungs (4 cases), CNS (2 cases) and bone (1 case). All cases but one were reported in patients with haematological malignancies.…”

“…In neutropenic patients, Fusarium may spread through a (endogenous) haematogenous route causing chorioretinitis and endophthalmitis . When the infection develops via haematogenous spread, prolonged systemic and intravitreal antifungal therapy with or without vitrectomy, and/or enucleation is required to control the infection and reduce the risk of CNS invasion …”

“…14 In neutropenic patients, Fusarium may spread through a (endogenous) haematogenous route causing chorioretinitis and endophthalmitis. 15 When the infection develops via haematogenous spread, prolonged systemic [15][16][17][18][19] and intravitreal antifungal therapy with or without vitrectomy, and/or enucleation is required to control the infection and reduce the risk of CNS invasion. 15,17,[19][20][21] Herein, we present a challenging case of disseminated fusariosis involving blood, skin and eye in a patient with acute lymphocytic leukaemia that responded to a combination antifungal therapy, repeated intravitreal instillations of voriconazole and bilateral vitrectomy.…”