Disseminated Fusarium infection identified by the immunohistochemical staining in a patient with a refractory leukemia

The difficulty and uncertainty encountered in diagnosing a systemic mycosis often lead to a delay in starting antifungal therapy. We reported a dissem inated infection of multiple fungal isolates including Fusarium species dur ing donor leukocyte transfusion (DLT) after allogeneic bone marrow transpla ntation in a 20-year-old woman with a refractory leukemia. Skin lesions are the feature of Fusarium and occur in the early period of the infection. In this case, during immunosuppression state after DLT, she presented with th e whole body ache and erythematous lesions which appeared rapidly on her tr unk and extremities. While administration of amphotericin B was started, he r condition was further deteriorated and she died. autopsy materials reveal ed that she had multiple fungal infection with different isolates, includin g Aspergillus and Candida in the brain, lung and liver, but not in the skin . With the immunohistochemical staining with specific antibody, Fusarium or Aspergillus infection was identified from the biopsy skin or autopsy brain , respectively. This rapid and specific immunohistochemical method may be u seful for the diagnosis and treatment of invasive fungal infection without delay. (C) 1999 Tohoku University Medical Press.