Disseminated Hormographiella aspergillata Infection with Lung and Brain Involvement after Allogenic Hematopoietic Stem-Cell Transplantation in a 54-Year-Old Man

Abstract

Hormographiella is a rare fungal pathogen in humans; however, case reports have described disseminated infection in immunocompromised hosts. This pathogen has been described to yield poor prognosis in patients who harbor it. Herein, we present a case report of autopsy-proven disseminated Hormographiella aspergillata infection, confirmed by DNA sequencing, in a patient experiencing a relapse of leukemia. This 54-year-old Caucasian man with chronic myelogenous leukemia (CML) that had been diagnosed in 1989, after having received a hematopoietic cell allotransplant from a compatible sibling donor, had B-cell lymphoid-blast phase of CML in April of 2013, with multiple relapses. His most recent relapse was in September of 2016, when bone marrow biopsy showed 90% blasts. The results of bronchoalveolar lavage (BAL) cultures were positive for filamentous fungus infection. The patient developed encephalopathy and worsening respiratory statusand tachycardia with flutter and hypotension, which resulted in his death. At autopsy, bilateral pleural effusions, multiple right pleural nodules, and subarachnoid hemorrhage were noted. Angioinvasive hyphal fungi were found in the right frontal lobe of the brain and the right upper lobe of the lung. Morphologically, the fungi had multiseptate, branching hyphae. The bronchoalveolar lavage specimen grew a fungus for which the colony morphologic characteristics and microscopic features were compatible with a Hormographiella species. H. aspergillata from the bronchoalveolar lavage was further identified by sequencing the D2 hypervariable region of the large-subunit (LSU) ribosomal DNA gene and the full internal transcribed spacer (ITS) regions.

Hormographiella aspergillata: an emerging basidiomycete in the clinical setting? A case report and literature review

“…It can be an opportunistic pathogen and is the second filamentous basidiomycete responsible for human infection after Schizophyllum commune [ 25 ]. To date, 22 invasive infections involving H. aspergillata have been reported (Table 2 ), mostly identified by sequencing of the 28S rDNA or ITS regions [ 2 , 5 – 22 ]. Most cases were diagnosed in Europe, but some were documented in the United States, Japan and India, in both rural and urban areas [ 2 , 5 – 22 ].…”

“…Although H. aspergillata is primarily responsible for pulmonary infections it can occasionally cause primary cutaneous lesions [ 10 , 14 , 19 ]. H. aspergillata is able to grow in blood cultures [ 11 ] and a few cases of disseminated infections have been reported, affecting the small intestine, the eye and the brain [ 11 , 16 , 17 , 22 ]. Interestingly, three cases of IFI have also been reported in immunocompetent patients following cardiac or ophthalmic surgery [ 2 , 9 , 21 ].…”

“…It was found in numerous environmental substrates and first reported as a human pathogen in 1971 [ 2 – 4 ]. Since, a few infections were reported all over the world with various clinical outcomes, essentially pulmonary but also disseminated or located to the eye or the skin [ 2 , 5 – 22 ]. Thus, data are sparse for the diagnosis and management of such infections.…”

Antifungal activity of Bacillussp. Gn-A11-18isolated from decomposing solid green household waste in water and soil against Candida albicans and Aspergillus niger

“…and microscopic (mycelial filaments, presence or absence of anastomosis loops and partitions, special structures, fruiting, spore and conidiophore diameter, etc.) characteristics using lactophenol cotton blue for A. niger [20]and methylene blue for C. albicans [21].…”

The Value of Predictive Nursing in Perioperative Period of Allogeneic Hematopoietic Stem Cell Transplantation

“…The total cost of patients receiving single nursing intervention was still lower than those who did not receive nursing intervention. Moreover, further analysis found that part of the higher costs came from expensive fortified antibiotic drugs, with antifungal drugs for lung infections accounting for the bulk of the cost, which was highly consistent with the high incidence of pulmonary infection during allo-HSCT [14].…”