Disseminated fusariosis presenting with pulmonary nodules following a line infection.

A 54 year-old male with severe emphysema steroiddependent was admitted to the hospital with perforated diverticulitis. Ten days following surgery and placement of a central venous catheter for antibiotic administration, the patient developed fever, chills, dyspnea, and nonproductive cough. Imaging studies demonstrated bilateral pulmonary nodules, including some with cavitation (Figure 1). Blood cultures grew a mold, which was later identified as Fusarium sp. (Figures 2-4). The patient’s central line was removed and he was treated with intravenous voriconazole for 14 days. Cultures of the catheter tip again revealed Fusarium sp. Fusarium spp. are common soil saprophytes that are associated with human infections both locally and systemically. Patients at most risk for disseminated fusariosis are those who are immunosuppressed, including those with neutropenia and patients being treated with corticosteroids or other immunosuppressive agents. The presentation is Figure 1. Bilateral pulmonary lesion, some with cavitation (arrow) were present on a thoracic CT scan. Figure 2. Sabouraud dextrose agar plate. showing the typical white, cottony, colony morphology of the Fusarium sp. Figures 3 and 4: Tease prep with lactophenol aniline blue stain demonstrating shorter, simple microconidia and the sickled, multiseptated, macroconidia, characteristic of Fusarium spp.