Disseminated fusariosis presenting as intracranial bleeding in a heart transplant recipient

Abstract

Background: Disseminated fusariosis is a serious fungal infection that primarily affects severely immunocompromised individuals. While it is well recognized in patients with hematologic malignancies and hematopoietic stem cell transplants (HSCT), it occurs far less frequently in solid organ transplant (SOT) recipients. Central nervous system (CNS) involvement is a rare clinical manifestation of disseminated fusariosis and has been scarcely reported in SOT recipients.

Case Summary: We report the first case of disseminated fusariosis with CNS involvement manifesting as intracranial bleeding in a heart transplant recipient. This is a 48-year-old male with non-ischemic cardiomyopathy with reduced ejection fraction (<15%) and an implantable cardioverter-defibrillator (ICD) placed >10 years ago, admitted with cardiogenic shock status post impella device placement, followed by orthotopic heart transplant. Hospital stay was complicated by a spontaneous large intraparenchymal hemorrhage within the right parieto-occipital lobe measuring 4.7 × 3.3 × 4.8 cm on day 43 of admission, followed by acute respiratory arrest and hemodynamic instability on day 65 requiring intubation and vasopressors. Blood cultures and CSF cultures revealed Fusarium falciforme. A thorough skin examination revealed several dark lesions, mainly over his thighs bilaterally, along with bilateral toenail changes concerning for onychomycosis. The patient received treatment with intravenous amphotericin (10 mg/kg/day) and voriconazole (4 mg/kg twice daily), but he rapidly decompensated and passed away.

Conclusion: While fusariosis is more prevalent among HSCT recipients, SOT patients remain at risk, and the outcomes of infection in this population can be equally devastating. Hence, early recognition and rapid initiation of antifungal therapy are crucial to improve patients’ outcomes.

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BibTeX RIS

BibTeX

@article{meski2026disseminated,
  title = {{Disseminated fusariosis presenting as intracranial bleeding in a heart transplant recipient}},
  author = {Nour El Meski and Praveen Gundelly and Sree Sarah Cherian},
  journal = {ASM case reports},
  year = {2026},
  month = sep,
  doi = {10.1128/asmcr.00056-26},
  url = {https://europepmc.org/article/PMC/PMC13729751},
  note = {CC BY},
}

RIS

TY  - JOUR
TI  - Disseminated fusariosis presenting as intracranial bleeding in a heart transplant recipient
AU  - Nour El Meski
AU  - Praveen Gundelly
AU  - Sree Sarah Cherian
PY  - 2026
DA  - 2026/09/23
JO  - ASM case reports
DO  - 10.1128/asmcr.00056-26
UR  - https://europepmc.org/article/PMC/PMC13729751
AB  - Background: Disseminated fusariosis is a serious fungal infection that primarily affects severely immunocompromised individuals. While it is well recognized in patients with hematologic malignancies and hematopoietic stem cell transplants (HSCT), it occurs far less frequently in solid organ transplant (SOT) recipients. Central nervous system (CNS) involvement is a rare clinical manifestation of disseminated fusariosis and has been scarcely reported in SOT recipients.  Case Summary: We report the first case of disseminated fusariosis with CNS involvement manifesting as intracranial bleeding in a heart transplant recipient. This is a 48-year-old male with non-ischemic cardiomyopathy with reduced ejection fraction (<15%) and an implantable cardioverter-defibrillator (ICD) placed >10 years ago, admitted with cardiogenic shock status post impella device placement, followed by orthotopic heart transplant. Hospital stay was complicated by a spontaneous large intraparenchymal hemorrhage within the right parieto-occipital lobe measuring 4.7 × 3.3 × 4.8 cm on day 43 of admission, followed by acute respiratory arrest and hemodynamic instability on day 65 requiring intubation and vasopressors. Blood cultures and CSF cultures revealed Fusarium falciforme. A thorough skin examination revealed several dark lesions, mainly over his thighs bilaterally, along with bilateral toenail changes concerning for onychomycosis. The patient received treatment with intravenous amphotericin (10 mg/kg/day) and voriconazole (4 mg/kg twice daily), but he rapidly decompensated and passed away.  Conclusion: While fusariosis is more prevalent among HSCT recipients, SOT patients remain at risk, and the outcomes of infection in this population can be equally devastating. Hence, early recognition and rapid initiation of antifungal therapy are crucial to improve patients’ outcomes.
SN  - 2996-2684
ER  -

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