DISSEMINATED ASPERGILLOSIS CAUSED BY ASPERGILLUS-USTUS IN A PATIENT FOLLOWING ALLOGENEIC PERIPHERAL STEM-CELL TRANSPLANTATION

The first case of disseminated aspergillosis caused by Aspergillus ust us in an allogeneic peripheral stem cell transplant patient is describ ed. The patient, a 46-year-old female with a history of myelodysplasti c syndrome, underwent high-dose chemotherapy and total body irradiatio n prior to transplantation. She was released from the hospital 49 days posttransplant (p.t.) in a stable condition with an absolute neutroph il count (ANC) of 2,700 cells per yl. Multiple antimicrobial agents, i ncluding itraconazole (ITR), were prescribed during hospitalization an d at the time of discharge. Three days after discharge, the patient wa s readmitted with hemorrhagic cystitis, persistent thrombocytopenia, a nd bilateral pulmonary consolidation, although no fever was present. T he ANC at the time of readmission was 3,500, Upon detection of a pulmo nary nodule (day 67 p.t.), a bronchoalveolar lavage was performed; the lavage fluid was positive for both cytomegalovirus and parainfluenza virus and negative for fungus. The patient was placed on ganciclovir, A biopsy specimen from a leg lesion also noted on day 67 p.t. revealed septate hyphae consistent with Aspergillus species, and a culture sub sequently yielded Aspergillus ustus. Confirmation detection of A. ustu s was made by demonstration of characteristic reproductive structures with the presence of Hulle cells. On day 67 p.t., ITR was discontinued and liposomal amphotericin B (AMB) was initiated. The patient's condi tion worsened, and she died 79 days p.t. At the time of autopsy, septa te hyphae were present in heart, thyroid, and lung tissues, with lung tissue culture positive ford. ustus. In vitro susceptibility testing i ndicated probable resistance to AMB but not to ITR, This case supports the need for the development of rapid methods to determine antifungal susceptibility.