ACREMONIUM RECIFEI FUNGEMIA AFTER AUTOLOG OUS BONE-MARROW TRANSPLANTATION

Objective. The ubiquitous fungi of the genus Acremonium are among the emerging fungal pathogens in immunocompromised patients. We report a c ase of central venous catheter-related fungaemia due to Acremonium rec ifei. Case report. A 58-year-old woman who was suffering from multiple myeloma received chemotherapy and autologous bone marrow transplantat ion. On day one she became febrile and antibiotic therapy associated w ith amphotericin B was begun. Neutropenia occurred three days later. A . recifei was isolated from 10 blood cultures despite antifungal thera py necessitating removal of the drug delivery system, culture of which also grew A. recifei. The patient was admitted to the Intensive Care Unit on day 12 because of severe sepsis and acute respiratory failure. Septic shock due to Pseudomonas aeruginosa bacteraemia occurred after transient improvement and the patient required mechanical ventilation and vasoactive drugs. Bronchoalveolar lavage was performed six weeks after initiation of antifungal therapy because of persistent fever and respiratory failure despite neutrophil recovery. Sabouraud dextrose a gar cultures were negative but electron microscopy examination reveale d mycelium forms similar to A, recifei in appearance. Amphotericin B t reatment was administered to a cumulated dose of 2.85 g but renal fail ure necessitated replacing the treatment with itraconazole 400 mg per day administered through the nasogastric tube. The patient eventually recovered after six weeks of neutropenia, 15 weeks of antifungal thera py and 20 weeks of hospitalisation in the Intensive Care Unit. Conclus ion. Invasive infection due to Acremonium species in immunocompromised patients remains difficult to treat and there is a high mortality rat e. Removal of the likely source of infection such as drug delivery sys tem is required, associated with neutrophil recovery and prolonged ant ifungal therapy.