Diagnostic and therapeutic challenges of treating opportunistic fungal cellulitis: a case series

• Published in: BMC infectious diseases Vol. 22; no. 1; p. 435
• Main Authors: Paul, Jed, Czech, Mary M, Balijepally, Ramya, Brown, Janice Wes
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.05.2022; BioMed Central; BMC
• Subjects: Aged; Amphotericin B; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antifungal agents; Antifungal Agents - therapeutic use; Bacteria; Bacterial diseases; Bacterial infections; Biopsy; Case Report; Case studies; Cellulitis; Cellulitis - diagnosis; Cellulitis - drug therapy; Cellulitis - microbiology; Diagnosis; Diagnostic errors; Dosage and administration; Drug therapy; Erythema; Fungal cellulitis; Fungal infections; Fungi; Fusarium; Fusarium solani; Health aspects; Hematopoietic Stem Cell Transplantation; Humans; Hypocreales; Immunocompromised; Immunocompromised host; Infectious diseases; Kidney transplantation; Lung transplantation; Male; Males; Middle Aged; Morbidity; Opportunist infection; Opportunistic infection; Pain; Pathology; Patients; Polymerase chain reaction; Posaconazole; Purpureocillium lilacinum; Risk factors; Skin diseases; Skin lesions; Soft tissues; Staphylococcus infections; Transplants & implants; Ulcers; Voriconazole; United States; Opportunistic infection; Fusarium solani; Fungal cellulitis; Purpureocillium lilacinum; Immunocompromised
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07365-8

Cellulitis is an infection most commonly caused by bacteria and successfully treated with antibiotics. However, certain patient populations, especially the immunocompromised, are at risk for fungal cellulitis, which can be misidentified as bacterial cellulitis and contribute to significant morbidity and mortality. We describe three cases of opportunistic fungal cellulitis in immunosuppressed patients that were initially mistaken for bacterial infections refractory to antibiotic therapy. However, atypical features of cellulitis ultimately prompted further diagnostics to identify fungal cellulitis and allow initiation of appropriate antifungals. We discuss: (1) a 52-year-old male immunosuppressed hematopoietic cell transplant recipient with Fusarium solani cellulitis on his right lower extremity that was treated with amphotericin B and voriconazole with full resolution of the cellulitis; (2) a 70-year-old male lung transplant recipient with Fusarium solani cellulitis on his left lower extremity that ultimately progressed despite antifungals; and (3) a 68-year-old male with a history of kidney transplantation with suspected Purpureocillium lilacinum cellulitis on his left lower extremity ultimately treated with posaconazole with resolution of the skin lesions. Fusarium solani and Purpureocillium lilacinum are important pathogens causing opportunistic fungal cellulitis. These cases remind providers to be vigilant for fungal cellulitis when skin and soft tissue infection does not adequately respond to antibiotics and atypical features of cellulitis are present.