DISSEMINATED INVASIVE INFECTION DUE TO METARRHIZIUM-ANISOPLIAE IN AN IMMUNOCOMPROMISED CHILD

The first reported human case of possible disseminated infection with the insect pathogen Metarrhizium anisopliae var. anisopliae, a fungus which has been used commercially for biocontrol of insects, is describ ed. The patient, a 9-year-old boy, had a 5-year history of pre-B-cell acute lymphoblastic leukemia and had been on chemotherapy throughout t his period, After 10 days of profound neutropenia, lesions consistent with ecthyma gangrenosum appeared on his arms and legs, AP. anisopliae was grown from specimens from three separate sites, collected at diff erent times over a period of 1 month: a skin biopsy, a swab from the b ase of a lesion, and the core of another skin lesion which spontaneous ly discharged, The initial skin biopsy also showed histological eviden ce of epidermal necrosis and dermal invasion with fungal hyphae, A com puted-tomography (CT) scan of the chest demonstrated a lesion in the s uperior segment of the lower lobe of the left lung, A CT scan of the b rain revealed a lesion in the left temporoparietal region of the brain , consistent with an abscess, Despite antifungal treatment including l iposomal amphotericin and 5-flucytosine, the patient eventually died, The initial portal of entry is unknown, but hematogenous dissemination to the skin appears likely because of the multiple ecthymic lesions, and the appearances of the brain lesion on the CT scan are consistent with a hematogenous fungal abscess.