A 47-year-old man with
acute myeloid leukemia and myelodysplastic-related changes relapsed after an allogenic bone marrow transplant and received a cord blood transplant as
salvage therapy. The patient developed
febrile neutropenia that was resistant to broad-spectrum
antibiotics and multiple, painful, nodular skin lesions on his trunk and extremities before engraftment. A skin biopsy and blood culture found mold, and the subsequent microscopic examination, mass spectrometry, and
DNA sequencing of the fungal colonies identified Fusarium solani. The patient's
fever and skin lesions began to improve with the administration of
liposomal amphotericin B at 5 mg/kg/day. Neutrophilic engraftment occurred on day 19. Stage 3 acute skin
graft-versus-host disease was cured by the application of topical
steroid. Unexpectedly, a change from
liposomal amphotericin B to
voriconazole on day 38 exacerbated the
Fusarium infection. The
Fusarium infection was finally cured by the administration of
liposomal amphotericin B for a total of 19 weeks. Neutrophilic engraftment, an immediate definitive diagnosis, the sufficient and long-term administration of appropriate antifungal medication, and avoidance of the systemic administration of
steroids might have contributed to the successful outcome of this patient.