Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Lane Building, L134 MC:5107, Stanford, CA, 94305-5107, USA.
Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA.
BMC Infect Dis. 2022 May 5;22(1):435. doi: 10.1186/s12879-022-07365-8.
Cellulitis is an infection most commonly caused by bacteria and successfully treated with antibiotics. However, certain patient populations, especially the immunocompromised, are at risk for fungal cellulitis, which can be misidentified as bacterial cellulitis and contribute to significant morbidity and mortality.
We describe three cases of opportunistic fungal cellulitis in immunosuppressed patients that were initially mistaken for bacterial infections refractory to antibiotic therapy. However, atypical features of cellulitis ultimately prompted further diagnostics to identify fungal cellulitis and allow initiation of appropriate antifungals. We discuss: (1) a 52-year-old male immunosuppressed hematopoietic cell transplant recipient with Fusarium solani cellulitis on his right lower extremity that was treated with amphotericin B and voriconazole with full resolution of the cellulitis; (2) a 70-year-old male lung transplant recipient with Fusarium solani cellulitis on his left lower extremity that ultimately progressed despite antifungals; and (3) a 68-year-old male with a history of kidney transplantation with suspected Purpureocillium lilacinum cellulitis on his left lower extremity ultimately treated with posaconazole with resolution of the skin lesions.
Fusarium solani and Purpureocillium lilacinum are important pathogens causing opportunistic fungal cellulitis. These cases remind providers to be vigilant for fungal cellulitis when skin and soft tissue infection does not adequately respond to antibiotics and atypical features of cellulitis are present.
蜂窝织炎是一种常见的感染，通常由细菌引起，并成功地用抗生素治疗。然而，某些患者群体，特别是免疫功能低下者，存在真菌性蜂窝织炎的风险，真菌性蜂窝织炎可能被误诊为细菌性蜂窝织炎，并导致严重的发病率和死亡率。
我们描述了三例免疫抑制患者的机会性真菌性蜂窝织炎，这些患者最初被误诊为对抗生素治疗无反应的细菌性感染。然而，蜂窝织炎的非典型特征最终促使进行了进一步的诊断，以确定真菌性蜂窝织炎，并允许开始使用适当的抗真菌药物。我们讨论了：（1）一名 52 岁的男性造血细胞移植受者，其右侧下肢患有茄病镰刀菌蜂窝织炎，用两性霉素 B 和伏立康唑治疗，蜂窝织炎完全消退；（2）一名 70 岁的男性肺移植受者，其左侧下肢患有茄病镰刀菌蜂窝织炎，尽管使用了抗真菌药物，但病情仍在进展；（3）一名 68 岁的男性，有肾移植史，左侧下肢疑似紫色毛癣菌蜂窝织炎，最终用泊沙康唑治疗，皮肤病变消退。
茄病镰刀菌和紫色毛癣菌是引起机会性真菌性蜂窝织炎的重要病原体。这些病例提醒医生，当皮肤和软组织感染对抗生素治疗反应不佳且存在蜂窝织炎的非典型特征时，要警惕真菌性蜂窝织炎的发生。
