PMC5536877_01
A- Left foot, ankle and lower legs showing erythema, swelling and nodules. B- Enlarged view of left medial heel nodule. C- Baseline CT chest. D- Week 3 CT chest with nodules and infiltrates (arrows). E- Week 15 CT chest with resolution of nodules and infiltrates. F- GMS 20x, showing Fusarium hyphae and spores identified in the left middle turbinate. G- H&E 20x, showing hyphae and spores in the bone of the nasal turbinate and surrounding soft tissues.
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At the time of presentation, he was noted to have firm, non-tender, erythematous subcutaneous nodules on his bilateral anterior lower limbs and painful edematous feet (Fig. 1A/B). A skin biopsy of one of these nodules was interpreted as septal panniculitis. In addition, there was interval development of bilateral focal patchy nodular pulmonary infiltrates with ground glass and reticular appearance on chest CT imaging (Fig. 1C/D), followed by development of paranasal sinusitis. Fusarium solani was isolated from all three of these sites (Fig. 1F/G). At day 100 following salvage chemotherapy, the CT showed resolution of the nodules (Fig. 1E) and Fungitell result normalized (< 60 pg/mL, Fig. 2A).
A- Relationship between ANC recovery, antifungal therapy and reduction in (1 3)-beta-D-glucan(B-D-Glucan) levels. Clo = Clofarabine. B- Use of granulocyte infusions to minimize neutropenia during allogeneic transplantation (SCT). Timing of granulocyte infusions shown with arrow. Note: Transplant day -11 is chemotherapy day 106. SCT conditioning done with Fludarabine (Flu), Cyclophosphamide (Cy) and Total Body Irradiation (TBI).
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G-CSF stimulated donors were scheduled for 5 doses during his transplant course (Fig. 2B) with average dose more than 0.6 x 109/kg.