Maniam Kali, Sabzwari Rabeeya, Carlsen Daniel
Department of Infectious Diseases, Loyola University Medical Center, Maywood, IL, USA.
Aurora Baycare Medical Center in Green Bay, Wisconsin.
IDCases. 2024 Dec 12;39:e02128. doi: 10.1016/j.idcr.2024.e02128. eCollection 2025.
Dematiaceous molds often cause noninvasive disease but have the potential to cause disseminated infection, particularly in immunosuppressed hosts. is the most neurotropic of dematiaceous molds and is associated with brain abscesses, but disseminated infection is quite rare. Here we present a case of disseminated in a 67-year-old renal transplant recipient with multifocal soft tissue, bone and presumed central nervous system involvement. infections have been associated with significant mortality and our patient had progression of his disease despite intensive dual antifungal therapy with close therapeutic drug monitoring. There was a delay in diagnosis and initiation of antifungal therapy as the multifocal disease was presumed to represent a malignant process. This case review highlights the importance of having a high index of suspicion for disseminated fungal infection in immunocompromised patients and the need for tissue biopsy to aid in the prompt and timely diagnosis and initiation of empiric antifungal therapy, with concomitant surgical management whenever possible to improve patient outcomes.
暗色真菌通常引起非侵袭性疾病，但有可能导致播散性感染，尤其是在免疫抑制宿主中。是暗色真菌中最具嗜神经性的，与脑脓肿有关，但播散性感染相当罕见。在此，我们报告一例67岁肾移植受者发生播散性感染的病例，该患者有多灶性软组织、骨骼受累，并推测有中枢神经系统受累。感染与显著的死亡率相关，尽管在密切的治疗药物监测下进行了强化的双重抗真菌治疗，我们的患者病情仍有进展。由于多灶性疾病被推测为恶性过程，因此在诊断和启动抗真菌治疗方面存在延迟。本病例回顾强调了对免疫受损患者的播散性真菌感染保持高度怀疑指数的重要性，以及进行组织活检以帮助及时诊断和启动经验性抗真菌治疗的必要性，同时尽可能进行手术处理以改善患者预后。
