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Lichtheimia Infection in a Lymphoma Patient: Case Report and a Brief Review of the Available Diagnostic Tools

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Abstract

We describe the case of a patient with a T-lymphoblastic lymphoma whose disseminated mucormycosis was diagnosed with delay, and we address the diagnostic and therapeutic decision-making process and review the diagnostic workup of patients with potential IFD. The diagnosis was delayed despite a suggestive radiological presentation of the patient’s pulmonary lesion. The uncommon risk profile (T-lymphoblastic lymphoma, short neutropenic phases) wrongly led to a low level of suspicion. The diagnosis was also hampered by the lack of indirect markers for infections caused by Mucorales, the low sensitivity of both fungal culture and panfungal PCR, and the limited availability of species-specific PCR. A high level of suspicion of IFD is needed, and aggressive diagnostic procedures should be promptly initiated even in apparently low-risk patients with uncommon presentations. The extent of the analytical workup should be decided on a case-by-case base. Diagnostic tests such as the galactomannan and β-d-glucan test and/or PCR on biological material followed by sequencing should be chosen according to their availability and after evaluation of their specificity and sensitivity. In high-risk patients, preemptive therapy with a broad-spectrum mould-active antifungal agent should be started before definitive diagnostic findings become available.

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Acknowledgments

The authors acknowledge the help by O. Petrini, Breganzona, Switzerland, in preparing the manuscript. The financial support by an Unrestricted Grant by Gilead is gratefully acknowledged. We also thank the patient for agreeing to have her case presented here.

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Authors and Affiliations

  1. Department of Infectious Diseases, Bern University Hospital, University of Bern, 3010, Bern, Switzerland

    Stefan Zimmerli

  2. LADR GmbH MVZ Dr. Kramer and Kollegen, Lauenburger Straße 67, 21502, Geesthacht, Germany

    Ralf Bialek

  3. Charité University Hospital, Benjamin Franklin Campus, Hindenburgdamm 30, 12200, Berlin, Germany

    Igor W. Blau

  4. Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, 3010, Bern, Switzerland

    Andreas Christe

  5. Division of Hygiene and Medical Microbiology, Medical University, Schöpfstr. 41, 6020, Innsbruck, Austria

    Cornelia Lass-Flörl

  6. Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Elisabeth Presterl

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  1. Stefan Zimmerli
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Correspondence to Stefan Zimmerli.

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Zimmerli, S., Bialek, R., Blau, I.W. et al. Lichtheimia Infection in a Lymphoma Patient: Case Report and a Brief Review of the Available Diagnostic Tools. Mycopathologia 181, 561–566 (2016). https://doi.org/10.1007/s11046-016-0010-y

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