Abstract
BackgroundSaksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown.Case presentationA 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived.ConclusionsWe describe an unusual case of disseminated infection with a favourable outcome to date.
Highlights
Saksenaea spp. are of the order Mucorales and are infrequent causes of mucormycosis worldwide [1]
We describe an unusual case of disseminated infection with a favourable outcome to date
We describe a case of disseminated infection by a Saksenaea species with a good clinical outcome and highlight rheumatological conditions as under-recognised risk factors for mucormycosis
Summary
Saksenaea spp. are of the order Mucorales and are infrequent causes of mucormycosis worldwide [1]. The isolate was referred to the National Mycology Reference Centre, where the fungus was identified as Saksenaea species (sp.) via sequencing of the internal transcribed spacer (ITS1– 5.8S-ITS2) region of the ribosomal deoxyribonucleic acid (DNA) and Nucleotide Basic Local Alignment Search Tool (BLASTn) comparison to publicly accessible sequence databases This demonstrated 93 and 91% sequence similarity to S. trapezispora and S. oblongispora Type material, respectively, in both the National Center for Biotechnology Information (NCBI) database (https:// blast.ncbi.nlm.nih.gov/) and the Westerdijk Fungal Biodiversity Institute database (http://www.wi.knaw.nl/Collections/BioloMICSSequences.aspx) [6], and 81% similarity to S. vasiformis using the International Society of Human and Animal Mycology (ISHAM) barcoding database (http://its.mycologylab.org/). The patient has received 18 months of posaconazole treatment with no evidence of recurrence of infection, and we remain cautiously optimistic
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