Disseminated <i>Fusarium</i> Infections in Patients Receiving Posaconazole Prophylaxis: A Report of 2 Patients and Brief Review of the Literature

Abstract

Fusarium is a filamentous fungi that has emerged as a frequent cause of invasive infections in immunocompromised patients. Dermatologists often play a critical role in diagnosing fusariosis, as greater than 70% of patients with disseminated infections have cutaneous involvement, and microbiologic evaluation of skin specimens provides the diagnosis in the majority of cases. Second-generation triazoles are typically the most effective medications in treating invasive Fusarium infections, and we discuss the benefits of using these medications, as well as detail the side effects of these therapeutic agents.

Cutaneous Hyalohyphomycosis and Its Atypical Clinical Presentations in Immunosuppressed Patients

“…Histopathologically, many of these fungi tend to invade blood vessels and produce hemorrhagic necrosis and tissue infarction [6], clinically presented as ulcerative lesions (e.g., Purpureocillium lilacinum) or eschars (e.g., Fusarium spp.) [17,18]. Figure 1 summarizes the spectrum of cutaneous hyalohyphomycosis, and associates various forms of cutaneous infections with the most common causative agent according to the reported cases.…”

“…Fusarium is a genus of saprophytic filamentous fungi belonging to the Nectriaceae family, with a worldwide distribution [17]. Fusarium spp.…”

“…In immunocompetent individuals, cutaneous infections are usually localized and typically follow trauma or progress from onychomycosis [17]. Although Fusarium spp.…”

“…In immunocompromised individuals, Fusarium spp. can cause a variety of invasive infections, including septic arthritis, endophthalmitis, osteomyelitis, sinusitis, keratitis, cystitis, brain abscesses, and disseminated infections [13,17,50]. Fusariosis is typically invasive, widespread, and potentially life-threatening in individuals with deep and prolonged neutropenia and/or severe T cell immunodeficiency [10].…”

“…Although disseminated infections are mostly the result of the inhalation of the pathogen, cutaneous infections in immunocompromised individuals may also serve as the beginning point for dissemination [10]. On the other hand, almost 70-75% of patients with a disseminated infection have some form of cutaneous involvement [17,50], which is why dermatologists are needed to recognize and raise suspicion about disseminated diseases. There are various forms of clinical presentations of cutaneous Fusarium infections in a disseminated disease, including painful erythematous papules and nodules, gray-colored rounded lesions, multiple necrotizing skin lesions resembling ecthyma gangrenosum, targetoid lesions, subcutaneous nodules, and others [13,17,50].…”