Fatal disseminated fusarium infection in acute lymphoblastic leukaemia in complete remission

Fusarium species are increasingly recognised as serious pathogens in the im munocompromised. The outcome in the context of persistent severe neutropeni a has been almost universally fatal. However, there have been several case reports of successful treatment if neutrophil recovery can be achieved. Thi s report presents the case of a fatality that occurred despite neutrophil r ecovery. A 67 year old man developed disseminated fusariosis during the neu tropenic phase of induction chemotherapy for acute lymphoblastic leukaemia. Fusarium dimerum was isolated from blood cultures. This species is highly unusual and very few case reports exist in the literature. An initial respo nse to amphotericin treatment coincided with neutrophil recovery but a subs equent relapse occurred, despite adequate neutrophil counts, which proved f atal. It is postulated that reseeding of the blood from an occult site, nam ely the right vitreum in this case, led to this secondary relapse despite a chieving complete leukaemic remission.