Intramedullary abscess in a patient with disseminated Scedosporium apiospermum infection

HAEMATOLOGYIntramedullary abscess in a patient with disseminated Scedosporium apiospermum infection A 35-year-old man was admitted with a relapsed acute lymphoblastic leukaemia (ALL).The initial diagnosis had been made 4 years earlier and at that time a proven invasive pulmonary aspergillosis had been successfully treated with voriconazole.Following initial chemotherapy, the patient entered complete remission.Following relapse, re-induction chemotherapy was given.During this chemotherapy, disseminated bluish-red cutaneous lesions developed over the entire trunk and head, despite oral itraconazole prophylaxis.The lesions initially had a clear vesicle, but subsequently developed central necrosis (top).A skin biopsy showed filamentous fungal elements (bottom left).Despite amphotericin B, liposomal amphotericin B, allogeneic granulocyte transfusions and, finally, voriconazole therapy, the fungal infection progressed with a microbiologically confirmed intraocular mycosis, orbital cellulitis and an intramedullary abscess (bottom right, arrow).Microbiological testing ultimately detected Scedosporium apiospermum.Despite sensitivity to voriconazole (and resistance to itraconazole, fluconazole, flucytosine and amphotericin B), confirmed by in vitro testing, and recovery from neutropenia, the patient developed multiple brain abscesses and died of progressive fungal infection.Scedosporium is a rare filamentous fungus subdivided into two species: S. prolificans and S. apiospermum.Because of its broad resistance to antifungal agents, infections in immunocompromised patients are often fatal.