Disseminated fusariosis presenting as intracranial bleeding in a heart transplant recipient
Nour El Meski, Praveen Gundelly, Sree Sarah CherianABSTRACT
Background
Disseminated fusariosis is a serious fungal infection that primarily affects severely immunocompromised individuals. While it is well recognized in patients with hematologic malignancies and hematopoietic stem cell transplants (HSCT), it occurs far less frequently in solid organ transplant (SOT) recipients. Central nervous system (CNS) involvement is a rare clinical manifestation of disseminated fusariosis and has been scarcely reported in SOT recipients.
Case Summary
We report the first case of disseminated fusariosis with CNS involvement manifesting as intracranial bleeding in a heart transplant recipient. This is a 48-year-old male with non-ischemic cardiomyopathy with reduced ejection fraction (<15%) and an implantable cardioverter-defibrillator (ICD) placed >10 years ago, admitted with cardiogenic shock status post impella device placement, followed by orthotopic heart transplant. Hospital stay was complicated by a spontaneous large intraparenchymal hemorrhage within the right parieto-occipital lobe measuring 4.7 × 3.3 × 4.8 cm on day 43 of admission, followed by acute respiratory arrest and hemodynamic instability on day 65 requiring intubation and vasopressors. Blood cultures and CSF cultures revealed
Conclusion
While fusariosis is more prevalent among HSCT recipients, SOT patients remain at risk, and the outcomes of infection in this population can be equally devastating. Hence, early recognition and rapid initiation of antifungal therapy are crucial to improve patients’ outcomes.