Basitruncatum Fungemia in a Patient with Acute

24 We report the first case of infection caused by Graphium basitruncatum in a man with 25 acute leukemia who developed persistent fungemia and skin lesions. G. basitruncatum, a 26 member of the Microascaceae, is phylogenetically and morphologically distinct from G. 27 penicilliodes and the opportunistic pathogens Scedosporium apiospermum 28 (Pseudallescheria boydii) and S. prolificans. 29 30 Case Report: 31 A 70-year-old man, previously in good health, was diagnosed with acute 32 myelogenous leukemia – FAB M0 in November 2005. The patient was originally from 33 Germany and had immigrated to Canada in 1983. He was admitted and received 34 induction chemotherapy with daunorubicin from days 1 to 3 and cytarabine from days 135 7. He was also given itraconazole 200 mg oral solution twice daily as antifungal 36 prophylaxis for four weeks starting on day 4 of chemotherapy. The post-induction course 37 was complicated by the development of fever and neutropenia (absolute neutrophil count 38 < 500 cells/μL) for which he received piperacillin/tazobactam and ciprofloxacin 39 intravenously. This resulted in resolution of fever after 1 week. Investigations including 40 blood cultures, urine cultures, and computed tomogram (CT) of the chest did not reveal a 41 source of infection. He failed to have adequate neutrophil recovery after the first course 42 of induction chemotherapy and was discharged from hospital on no antimicrobials with 43 an absolute neutrophil count of zero cells/μl. 44 Three weeks later, the patient was re-hospitalized with febrile neutropenia. His 45 physical examination was remarkable for several non-tender, erythematous skin nodules 46 AC CE PT ED on N ovem er 5, 2017 by gest ht://jcm .sm .rg/ D ow nladed fom