Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 48, Num. 1, 2011, pp. 116-117

Indian Journal of Cancer, Vol. 48, No. 1, January-March, 2011, pp. 116-117

Letter to Editor

Fusarial skin lesion in immunocompromised

SB Gurusidappa¹, HS Mamatha²

¹ Department of Microbiology, Kidwai Memorial Institute of Oncology, Bangalore 560 029, India
² Department of Paediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore 560 029, India

Correspondence Address:
S B Gurusidappa
Department of Microbiology, Kidwai Memorial Institute of Oncology, Bangalore 560 029
India
hyma_68@yahoo.com

Code Number: cn11023

Sir,

Fungi, previously considered to be harmless colonizers, are now emerging as a significant pathogen in immunocompromised patients, in particular reference is the Fusarium species. ^[1]

A 6-year-old male child diagnosed as acute lymphocytic leukemia (ALL) was admitted with history of high grade, intermittent fever, and history of left knee injury since 2 months. On examination, the patient was febrileand pale with left cervical lymphadenopathy. A hematoma (4 cm × 4 cm) was present over left knee joint.

X-ray of left knee showed evidence of swelling with collection of fluid within the joint. Diagnosis was acute arthritis, probably traumatic arthritis. Patient was put on parenteral cefuroxime and tobramycin. Slough excision and debridement of wound was done under general anesthesia. Conventional culture of the excised wound on McConkey and to blood agar plates grew pinkish-white and white colonies, respectively, after 24 h.

Sabouraud′s dextrose agar plates showed pinkishwhite, cottony growth. Lacto phenol cotton blue preparation showed septate branching hyphae with clusters of sickle-shaped microconidia. The above morpholological features w reconfirmed by slide culture technique. Consecutive three samples yielded same growth. The pathogen was confirmed as Fusarium oxysporum [Figure - 1] I.V. amphoptercin-B was changed to ketoconazole (an azole group of antifungal agent) after which there was marked improvement in healing of the lesion [Figure - 2]

A high index of suspicion especially for skin lesions will help in early diagnoses before systemic and visceral dissemination can occur. Excision of the initial focus of infection and antifungal therapy aided by speedy neutrophil recovery are likely to protect patients threatened with these fatal infections. ^[2]

Fungal infections have emerged as one of the most importantsignificant complications of antineoplastic therapy and marrow transplantation in children. Recent trends indicate that the incidence and spectrum of fungal infections are increasing, partly because of the successful management of bacterial and viral infections.^[3]

Aggressive cytostatic regimens used for patients with hematological malignancies have favored the emergence of fusarium infections. ^[4]

Most fusarial infections are refractory to amphotericin B-lipid complex but respond successfully to voriconazole.

A comprehensive review of skin lesions in a hematological malignancy, with a propensity for invasive fungal infections (IFI) should be borne in mind, particularly in reference to suspicious fungal infections of skin.

Acknowledgments

Department of Mycology, Post Graduate Institute of Medical Sciences, Chandigarh.

References

Copyright 2011 - Indian Journal of Cancer

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