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Journal of Clinical Microbiology, December 1998, p. 3713-3717, Vol. 36, No. 12
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Disseminated Aspergillosis Caused by Aspergillus ustus in a Patient Following Allogeneic Peripheral Stem Cell Transplantation

Peter C. Iwen,1,* Mark E. Rupp,2 Michael R. Bishop,2 Michael G. Rinaldi,3,4 Deanna A. Sutton,3 Stefano Tarantolo,2 and Steven H. Hinrichs1

Departments of Pathology and Microbiology1 and Internal Medicine,2 University of Nebraska Medical Center, Omaha, Nebraska, and Fungus Testing Laboratory, Department of Pathology, University of Texas Health Science Center at San Antonio,3 and Audie L. Murphy Division, South Texas Veterans Health Care System,4 San Antonio, Texas

Received 18 May 1998/Returned for modification 9 July 1998/Accepted 15 September 1998

The first case of disseminated aspergillosis caused by Aspergillus ustus in an allogeneic peripheral stem cell transplant patient is described. The patient, a 46-year-old female with a history of myelodysplastic syndrome, underwent high-dose chemotherapy and total body irradiation prior to transplantation. She was released from the hospital 49 days posttransplant (p.t.) in a stable condition with an absolute neutrophil count (ANC) of 2,700 cells per µl. Multiple antimicrobial agents, including itraconazole (ITR), were prescribed during hospitalization and at the time of discharge. Three days after discharge, the patient was readmitted with hemorrhagic cystitis, persistent thrombocytopenia, and bilateral pulmonary consolidation, although no fever was present. The ANC at the time of readmission was 3,500. Upon detection of a pulmonary nodule (day 67 p.t.), a bronchoalveolar lavage was performed; the lavage fluid was positive for both cytomegalovirus and parainfluenza virus and negative for fungus. The patient was placed on ganciclovir. A biopsy specimen from a leg lesion also noted on day 67 p.t. revealed septate hyphae consistent with Aspergillus species, and a culture subsequently yielded Aspergillus ustus. Confirmation detection of A. ustus was made by demonstration of characteristic reproductive structures with the presence of Hülle cells. On day 67 p.t., ITR was discontinued and liposomal amphotericin B (AMB) was initiated. The patient's condition worsened, and she died 79 days p.t. At the time of autopsy, septate hyphae were present in heart, thyroid, and lung tissues, with lung tissue culture positive for A. ustus. In vitro susceptibility testing indicated probable resistance to AMB but not to ITR. This case supports the need for the development of rapid methods to determine antifungal susceptibility.

* Corresponding author. Mailing address: Department of Pathology and Microbiology, University of Nebraska Medical Center, 600 South 42nd St., Omaha, NE 68198-6495. Phone: (402) 559-7774. Fax (402) 559-4077. E-mail: piwen{at}unmc.edu.

Journal of Clinical Microbiology, December 1998, p. 3713-3717, Vol. 36, No. 12
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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