# Invasive Conidiobolus infection in an immunocompromised pediatric patient in Southern California

## TL;DR

A 15-year-old immunocompromised boy in California developed a rare invasive fungal infection caused by Conidiobolus, which was identified through advanced DNA sequencing and treated with antifungal drugs.

## Contribution

Reports a rare case of invasive Conidiobolus infection in a pediatric immunocompromised patient in North America.

## Key findings

- Conidiobolus species were identified as the causative agent through plasma cell-free DNA sequencing.
- The organism showed high resistance to antifungal agents in vitro.
- The patient was successfully treated with posaconazole and trimethoprim-sulfamethoxazole.

## Abstract

Conidiobolus species are largely known to cause rhinofacial cellulitis in healthy individuals but can manifest as an invasive infection in immunocompromised patients. Few cases have been described in the literature as they are difficult to diagnose and rarely observed in North America, particularly in the pediatric population.

A 15-year-old boy with a history of multiple bone marrow transplants for mixed phenotype acute leukemia presented to the emergency department with febrile neutropenia and chills. His clinical course was complicated by potential Rothia mucilaginosa bacteremia, but imaging revealed a potential invasive pulmonary fungal infection. Following rapid decompensation and admission in the intensive care unit, plasma cell-free DNA sequencing was ordered, identifying Conidiobolus species. The same organism was then isolated in the patient’s sputum culture shortly thereafter. This organism was found to demonstrate high minimum inhibitory concentration to antifungals tested in vitro. Ultimately, the patient was discharged on posaconazole and trimethoprim-sulfamethoxazole.

Conidiobolus can be an agent of invasive fungal infection and may be considered a potential infectious agent in the immunocompromised patient. Treatment and outcomes of invasive Conidiobolus remain elusive.