450: FUSARIUM OXYSPORUM-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME IN AN IMMUNOCOMPETENT HOST

Abstract

Introduction: Fusarium species is an environmental mold that historically causes systemic illness in immunocompromised individuals, predominantly those with acute leukemia or allogenic stem cell transplant recipients. Here we present an immunocompetent patient with acute respiratory distress syndrome (ARDS) secondary to Fusarium oxysporum. Description: A 68 y.o. male with no significant past medical history was admitted for acute hypoxic respiratory failure due to multifocal pneumonia. After initial improvement on antibiotics, his respiratory status decompensated to the point of mechanical ventilation with low tidal volume for ARDS. Cell count with differential from bronchoalveolar lavage revealed 99 nucleated cells with 44% neutrophils, 27% lymphocytes, 2% eosinophils, and 5000 red blood cells. Additional studies were negative for viral, fungal, bacterial and malignant causes. Connective tissue causes were ruled out. High-dose steroids were started for possible cryptogenic organizing pneumonia, but the patient failed to recover. Further inquiry revealed that he was caring for two red squirrels, one of which he attempted mouth to mouth resuscitation. Infectious disease was consulted and began anti-fungal therapy given his exposure history. Extensive infectious workup including testing for tularemia, brucella, bartonella, hantavirus, and lymphocytic choriomeningitis virus was negative. Home well water testing was negative. Karius Test™ was performed on serum and positive for 11 pathogens, HSV-1 and Fursarium oxysporum having the highest concentrations. Consulting teams determined that the patient’s presentation was most consistent with a fungal pneumonia, so treatment was narrowed to isavuconazole. He was eventually discharged on voriconazole and a steroid taper. Discussion: There are few reports of Fusarium species related ARDS. Extensive literature review showed only one previous case of ARDS secondary to Fusarium oxysporum. Because of the rarity of this infection, definitive diagnosis is often delayed with send-out testing. This leads to treatment delay of an already highly resistant fungus. Even if an early diagnosis is made, anti-fungal therapies are limited to amphotericin and voriconazole. For this reason, early identification is integral to improving patient outcomes.