Fusarium vascular graft infection

A 37-year-old African American male with a past medical history significant for end stage renal disease on hemodialysis via a femoral arteriovenous graft, systemic lupus erythematous, with a recent hospitalization for cavitary Candida pneumonia treated with micafungin, presented with a fever of 102° F for 3 days and worsening left groin pain. He also complained of chills, nausea, and malaise. On physical examination, the patient was hemodynamically stable with swelling and tenderness at the site of the graft. He was started on vancomycin, piperacillin/tazobactam and micafungin. Computed tomography scan and duplex scan of the left lower extremity showed diffuse swelling and attenuation of the graft material consistent with thrombosis of the graft. Excision of the graft and thrombectomy was performed and the graft thrombus was sent for culture. Examination of the sample showed fungal hyphae (Figure). Micafungin was switched to voriconazole; however, the patient did not show any improvement of his groin pain. On day 5 of hospitalization, culture showed Fusarium, and hence amphotericin B was added resulting in subsequent clinical improvement. We are presenting an unusual site of Fusarium infection which responded to combination therapy, a case which has not been reported.