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Case report and review of resolved fusariosis

  • Author Footnotes
    a From the Department of Dermatology, The Cleveland Clinic Foundation.
    Thomas N. Helm
    Correspondence
    Reprint requests: Thomas N. Helm, MD, Department of Dermatology, A61, Cleveland Clinic Foundation, One Clinic Center Drive, Cleveland, OH 44195-0338.
    Footnotes
    a From the Department of Dermatology, The Cleveland Clinic Foundation.
    Affiliations
    Cleveland, Ohio, USA
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  • Author Footnotes
    b From the Department of Infectious Disease, The Cleveland Clinic Foundation.
    David L. Longworth
    Footnotes
    b From the Department of Infectious Disease, The Cleveland Clinic Foundation.
    Affiliations
    Cleveland, Ohio, USA
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  • Author Footnotes
    c From the Department of Microbiology, The Cleveland Clinic Foundation.
    Geraldine S. Hall
    Footnotes
    c From the Department of Microbiology, The Cleveland Clinic Foundation.
    Affiliations
    Cleveland, Ohio, USA
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  • Author Footnotes
    d From the Department of Hematology-Oncology, The Cleveland Clinic Foundation.
    Brian J. Bolwell
    Footnotes
    d From the Department of Hematology-Oncology, The Cleveland Clinic Foundation.
    Affiliations
    Cleveland, Ohio, USA
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  • Author Footnotes
    e From the Department of Internal Medicine, The Cleveland Clinic Foundation.
    Bernard Fernandez
    Footnotes
    e From the Department of Internal Medicine, The Cleveland Clinic Foundation.
    Affiliations
    Cleveland, Ohio, USA
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  • Author Footnotes
    a From the Department of Dermatology, The Cleveland Clinic Foundation.
    Kenneth J. Tomecki
    Footnotes
    a From the Department of Dermatology, The Cleveland Clinic Foundation.
    Affiliations
    Cleveland, Ohio, USA
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  • Author Footnotes
    a From the Department of Dermatology, The Cleveland Clinic Foundation.
    b From the Department of Infectious Disease, The Cleveland Clinic Foundation.
    c From the Department of Microbiology, The Cleveland Clinic Foundation.
    d From the Department of Hematology-Oncology, The Cleveland Clinic Foundation.
    e From the Department of Internal Medicine, The Cleveland Clinic Foundation.
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      Erythematous macules, nonpalpable and palpable purpura, and flaccid pustules developed in a 59-year-old man with acute lymphocytic leukemia 8 days after reinduction chemotherapy with cytosine arabinoside and daunorubicin. Tissue and blood cultures grew Fusarium proliferatum, and a skin biopsy specimen revealed fungal vasculitis. Anemia and muscle weakness accompanied the disseminated infection, for which the patient received granulocyte transfusions and amphotericin B, ketoconazole, rifampin, and griseofulvin. Skin lesions and fungemia resolved with recovery of the bone marrow, and 51 days after the completion of his chemotherapy he returned home. If promptly recognized and aggressively treated, disseminated fusariosis is responsive to therapy. Infection with Fusarium species should be suspected in profoundly neutropenic patients in whom disseminated palpable purpura and myositis develop concomitantly.
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