Acute lymphoblastic leukemia with Fusarium solani infection: a case report

TL;DR

A 27-year-old ALL patient developed a rare Fusarium solani skin infection during chemotherapy, successfully treated with a combination of antifungal therapies and supportive care.

Contribution

This case report highlights the diagnostic and therapeutic challenges of Fusarium solani infection in ALL patients and emphasizes the importance of early combined antifungal treatment.

Findings

Fusarium solani infection presented as multifocal cutaneous lesions in an ALL patient undergoing chemotherapy.

Combined systemic and topical antifungal therapy, along with neutrophil support, effectively controlled the infection.

Early diagnosis and multidisciplinary care improved outcomes in this rare infection case.

Abstract

Fusarium infections are rare but life-threatening in immunocompromised patients, particularly those with acute lymphoblastic leukemia (ALL) undergoing chemotherapy. This case report describes a patient with ALL who developed multifocal cutaneous Fusarium solani infections following VDCLP chemotherapy, highlighting the challenges in diagnosis and management.

A 27-year-old male ALL patient developed cutaneous infections on the right calf, left upper arm, and buttock during chemotherapy. Initial lesions presented as a 1.0 × 1.0 cm dark purple nodule on the right calf, progressing rapidly to black eschar, ulceration, and multiple metastatic lesions. Fusarium solani was confirmed via microbiological culture and molecular testing. Treatment included systemic voriconazole, local debridement, topical liposomal amphotericin B, G-CSF for neutrophil recovery, and psychological intervention for anxiety. The infections were effectively controlled with gradual wound healing, and no recurrence was observed during 2 months of follow-up.

Unusual skin lesions in immunocompromised patients, especially those with hematological malignancies receiving chemotherapy, warrant high suspicion for Fusarium infection. Timely microbiological diagnosis and early initiation of combined systemic-topical antifungal therapy, alongside neutrophil support and multidisciplinary care, are critical for improving outcomes.

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