Reactions 1704, p254 - 2 Jun 2018 Disseminated line-related bloodstream Volvariella volvacea infection involving the brain, lung and skin: case report A 45-year-old man developed fatal disseminated line-related bloodstream Volvariella volvacea infection involving the brain, lung and skin during treatment with cyclophosphamide, vincristine, cytarabine, doxorubicin, dexamethasone, folinic acid, methotrexate and methylprednisolone [dosages and durations of treatments to reactions onsets not stated; not all routes stated]. The man was diagnosed with T-cell acute lymphoblastic leukaemia in October 2016. He started receiving treatment with hyper-CVAD regimen consisting of cyclophosphamide, intrathecal cytarabine, vincristine, doxorubicin, dexamethasone, folinic acid, methotrexate and methylprednisolone. Additionally, he received prophylactic treatment with fluconazole. He completed the first cycle of hyper-CVAD regimen. Subsequently, the treatment was complicated by a line-related bloodstream infection and intermittent confusion. A brain MRI revealed ring-enhancing lesions. CT scan of the thorax revealed nodules and cavitation. The man started receiving empiric treatment with ceftriaxone and his fluconazole prophylaxis was switched to posaconazole. The findings of brain biopsy, lumbar puncture and bronchoalveolar lavage did not led to any diagnosis. Three weeks later, a repeat CT scan of the thorax and MRI of the brain revealed improvement of the lesions. Subsequently, he received second cycle of the hyper-CVAD regimen in December 2016. One day later, he exhibited deterioration, and developed another line-related infection. A repeat MRI of the brain revealed newly developed nodules. Once again the brain biopsy showed no diagnosis. He became progressively obtunded, and he was treated with amphotericin B liposomal [liposomal amphotericin B], pyrimethamine, meropenem, clindamycin and folinic acid. Subsequently, he developed new skin nodules, and a biopsy was performed. Histological findings revealed broad-appearing fungal hyphae. The infection involved the skin, brain and lung. Few days later, he died due to the infection. Subsequently, skin biopsy culture was found positive for light brown coloured mould. Molecular sequencing confirmed presence of Volvariella volvacea (straw mushroom). Author comment: "He was treated with the first cycle of hyper-CVAD regimen and intrathecal cytarabine with fluconazole prophylaxis. His treatment was complicated by a line-related bloodstream infection and intermittent confusion." "Skin biopsy culture grew colonies of a light brown coloured mould. It was identified as Volvariella volvacea by molecular sequencing." "This infection involved the brain, lung and skin, and was eventually fatal." Wang DA, et al. Straw mushroom causing fatal, disseminated disease in a patient with acute leukaemia. International Journal of Antimicrobial Agents 50 (Suppl. 2): S196, Nov 2017 [abstract] - Singapore 803323407 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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