Abstract

Fusarium solani is a well-established plant pathogen and mycotoxigenic filamentous fungus with the ability to cause opportunistic mycoses in severely immunocompromised humans. We present one such case. A 65-year-old male with history of myelodysplastic syndrome, status-post allogenic hematopoietic stem cell transplant (HSCT), with Graft vs. Host Disease (GVHD) on prednisone and multiple antibiotics presented with a 10-day duration of right lower extremity cellulitis, diffuse purulent draining cutaneous sinuses, violaceous plaques, eschars, and ulcerations. IV antibiotics were initiated, and work up for vasculitis, cellulitis, and fungal infection were performed. Imaging showed extensive right foreleg soft tissue edema with ulcerations and numerous subcutaneous abscesses, without osteomyelitis. Punch biopsy revealed necrosis, and hemorrhage with diffuse histiocytic and giant cell inflammatory infiltrate. Fungal elements were identified; the initial interpretation demonstrated concern for a dermatophyte infection or blastomycoses. Additional tissue was sent for PCR and further identification/susceptibility of the pathogen. The cultures ultimately revealed F. solani, and the patient was treated with posaconazole for an invasive cutaneous infection. F. solani is an emerging opportunistic infection in immunocompromised hosts, capable of causing superficial disease and invasive disseminated infections through inoculation, inhalation or ingestion. Those with profound neutropenia, in the setting of bone-marrow transplantation, induction chemotherapy, or prolonged steroid therapy, are arguably the most susceptible . It is important to recognize this emerging pathogen as a cause of cutaneous infection in immunosuppressed individuals, given it similar morphology to other more common fungal species like aspergillus and blastomycoses, or modified morphology in the setting of extensive antibiotic therapy.

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