Isolation Of Acremonium sp. From Subcutaneous Skin Infection Of A Patient With Chronic Lymphocytic Leukemia

Year 2016, Volume: 2 Issue: 1, 44 - 46, 31.01.2016

Sema Keçeli Devrim Dündar , Aysun Şikar Aktürk , Rebiay Kıran

https://doi.org/10.30934/kusbed.358499

Abstract

Cutaneous Acremonium infections in humans is rare. We report a patient with chronic lymphocytic leukemia who developed subcutaneous infection due to Acremonium sp. A wound lesion on distal wall of left lower leg was the first clinical manifestation of the patient. Fungal culture of deep tissue biopsy from the lesion revealed Acremonium species. In bacterial cultures Enterecoccus faecalis, E. clocea and Candida albicans were isolated. Pathologic investigation resulted as pyoderma gangrenosum and T cell lymphoproliferative lesion. Thus, the diagnosis of patient was considered as combined bacterial and fungal infection plus pyoderma gangrenosum. Thus, the patient was treated with ampicillin/sulbactam, methil prednisolone, topical naftifin and fucidic acid and itraconazole. The chemotherapy protocol was continued at the same time. Healing of the lesion was observed after ıtracanazoleteratment.

Keywords

Acremonium, fungus, leukemia, skin, infection, immunosuppresion, itraconazole, amphotericin B

Kronik Lenfositik Lösemili Hastanın Subkütan Deri Enfeksiyonunda Acremonium Türlerinin İzolasyonu

Abstract

Kutanöz Acremonium enfeksiyonları insanlarda nadir görülmektedir. Burada Acremonium sp. bağlı subkütanöz enfeksiyon gelişen kronik lenfositik lösemili bir olgu sunulmaktadır. Olgunun ilk klinikbelirtisi, sol bacak alt bölge dış yan duvarında meydana gelen yara lezyonu idi. Lezyondan alınan derin doku biyopsi örneğinin mantar kültüründe Acremonium sp. izole edildi. Bakteriyel kültürde Enterecoccus faecalis, E. clocea ve Candida albicans izole edildi. Patolojik inceleme sonucu piyoderma gangrenosum ve T hücre lenfo proliferatif lezyon olarak sonuçlandı. Bu nedenle olgunun tanısı, kombine bakteriyel ve fungal enfeksiyon, ayrıca pyoderma gangrenosum olarak belirlendi. Olgumuza ampisilin/sulbaktam, metilprednizolon, topikalnaftifin, fusidikasid vei trakonazol tedavisi verildi. Aynı zamanda kemoterapi protokolüne devam edildi. Itrakonazol tedavisinden sonar lezyonda iyileşme gözlendi.

Keywords

Acremonium, fungus, lösemi, deri, enfeksiyon, immünsupresyon, ıtrakanazol, amfoterisin B

References

• Schell AW, Perfect JR. FataldiseminatedAcremoniumstrictuminfection in aneutropenichost. J ClinMicrobiol. 1996; 34: 1333-36.
• Guarro J, Gams W, Pugol I et al. Acremoniumspecies: newemergingfungalopportunists-in vitroantifungalsusceptibilitiesandreview.ClinInfectDis. 1997; 25: 1222-1236.
• Koç AN, Utaş C, Oymak O et al. Peritonitis due to Acremonium strictum in a patienton continous ambulatory peritoneal dialysis. Nephron. 1998; 79: 357-358.
• Strabelli TM, Uip DE, Amato Neto V et al. Acremonium infection after heart transplant. Rev Soc Bras Med Trop. 1990; 22: 233.
• Miro O, Fernando J, Lecha V, et al. Abcesos subcutae nos por Acremonium falciforme en un transplanta do renal. Med Clin (Barc). 1994; 102:316.
• Fincher RME, Fisher JF, Lovell RD et al Infection due to the fungus Acremonium (Cephalosporium). Medicine. 1991; 70: 398-409.
• Fridkin SK, Kremer FB, Bland LA et al. Acremonium kiliense endophtalmitis that occurred after cataract extraction in anambulatory surgical centre that was traced to an environmental reservoir. Clin Infect Dis. 1996; 22: 222-227.
• Koc NA, Erdem F, Patıroglu T. Case report: Acremonium falciforme fungemia in a patient with acute leukemia. Mycoses. 2000; 45: 202-203.
• Tuon FF, Pozzi C, Penteado-Filho SR et al. Reccurrent Acremoniumin fection in a kidney transplant patient treated with voriconazole: a casereport. Rev Soc Bras Med Trop. 2010; 43: 467-468.