Chauhan Aastha, Gruenberg Jessica, Arbefeville Sophie, Mettler Tetyana, Brent Clark H, Ferrieri Patricia
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota.
Lab Med. 2019 Oct 10;50(4):426-431. doi: 10.1093/labmed/lmz018.
Hormographiella is a rare fungal pathogen in humans; however, case reports have described disseminated infection in immunocompromised hosts. This pathogen has been described to yield poor prognosis in patients who harbor it. Herein, we present a case report of autopsy-proven disseminated Hormographiella aspergillata infection, confirmed by DNA sequencing, in a patient experiencing a relapse of leukemia. This 54-year-old Caucasian man with chronic myelogenous leukemia (CML) that had been diagnosed in 1989, after having received a hematopoietic cell allotransplant from a compatible sibling donor, had B-cell lymphoid-blast phase of CML in April of 2013, with multiple relapses. His most recent relapse was in September of 2016, when bone marrow biopsy showed 90% blasts. The results of bronchoalveolar lavage (BAL) cultures were positive for filamentous fungus infection. The patient developed encephalopathy and worsening respiratory statusand tachycardia with flutter and hypotension, which resulted in his death. At autopsy, bilateral pleural effusions, multiple right pleural nodules, and subarachnoid hemorrhage were noted. Angioinvasive hyphal fungi were found in the right frontal lobe of the brain and the right upper lobe of the lung. Morphologically, the fungi had multiseptate, branching hyphae. The bronchoalveolar lavage specimen grew a fungus for which the colony morphologic characteristics and microscopic features were compatible with a Hormographiella species. H. aspergillata from the bronchoalveolar lavage was further identified by sequencing the D2 hypervariable region of the large-subunit (LSU) ribosomal DNA gene and the full internal transcribed spacer (ITS) regions.
霍氏真菌属是人类罕见的真菌病原体；然而，病例报告描述了其在免疫功能低下宿主中的播散性感染。据描述，这种病原体在携带它的患者中预后较差。在此，我们报告一例经尸检证实的播散性阿氏霍氏真菌感染病例，该病例通过DNA测序得以确诊，患者为一名白血病复发患者。这名54岁的白人男性于1989年被诊断为慢性粒细胞白血病（CML），在接受了来自一位匹配同胞供体的造血细胞同种异体移植后，于2013年4月进入CML的B细胞淋巴母细胞期，并多次复发。他最近一次复发是在2016年9月，当时骨髓活检显示90%为原始细胞。支气管肺泡灌洗（BAL）培养结果显示丝状真菌感染呈阳性。患者出现脑病，呼吸状况恶化，伴有扑动性心动过速和低血压，最终导致死亡。尸检时，发现双侧胸腔积液、多个右侧胸膜结节和蛛网膜下腔出血。在大脑右额叶和肺右上叶发现血管侵袭性菌丝真菌。形态学上，这些真菌具有多隔、分支的菌丝。支气管肺泡灌洗标本培养出一种真菌，其菌落形态特征和微观特征与霍氏真菌属相符。通过对大亚基（LSU）核糖体DNA基因的D2高变区和完整的内部转录间隔区（ITS）进行测序，进一步鉴定了支气管肺泡灌洗中的阿氏霍氏真菌。
