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Neosartorya udagawae pulmonary infection requiring a surgical treatment in a paediatric haematopoietic progenitor cell recipient

Summary

A three-year-old boy with leukemia received a bone marrow transplant and developed a serious fungal lung infection caused by Neosartorya udagawae, a rare fungal pathogen. Despite receiving multiple antifungal medications at appropriate doses, the infection continued to worsen and spread in his lungs. Doctors ultimately had to surgically remove the infected portion of his lung (left upper lobe) to successfully treat the infection, and the child recovered completely without recurrence after three years of follow-up.

Background

Neosartorya udagawae is a rare fungal pathogen related to Aspergillus fumigatus that causes refractory infections in immunocompromised patients. Haematopoietic stem cell transplant (HSCT) recipients are at high risk for invasive fungal disease, which is a common cause of mortality in this population.

Objective

To present a case of proven invasive Neosartorya udagawae infection in a pediatric patient with chronic myeloid leukaemia after HSCT, demonstrating the challenges of antifungal-refractory disease and the potential requirement for surgical management.

Results

A three-year-old boy developed progressive pulmonary Neosartorya udagawae infection despite dual and triple antifungal therapy. The organism showed elevated MICs to most azoles but low MICs to amphotericin B and echinocandins. Left upper lobe lobectomy was performed after disease progression, with confirmed resolution of infection and normalization of biomarkers at 16 months post-surgery.

Conclusion

Combined targeted antifungal therapy and surgical debulking achieved successful outcome in this case of refractory Neosartorya udagawae disease. Early biopsy with antifungal susceptibility testing and consideration of surgical management are important in managing refractory invasive fungal disease in severely immunocompromised patients.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 38617461, DOI: 10.1016/j.mmcr.2024.100645
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