Fast and Fusariosis: a systematic review and case report of a rapidly fatal central nervous system infection

Background: Immunocompromised transplant recipients are at risk for fungal infections. Fusarium spp., however, are a ubiquitous environmental fungus that has rarely been reported to cause invasive central nervous system (CNS) infection in patients post solid organ transplant. Case Description: We report a 57-year-old male with a recent heart transplant on immunosuppressive therapy who presented to the emergency department with right eye pain, headache, and focal neurologic deficits, and was subsequently diagnosed with CNS Fusariosis and endophthalmitis. Following intensive care and operative management, the patient ultimately suffered from acute transplant rejection and passed away shortly thereafter. One day following the surgery, the patient demonstrated signs of acute heart failure, and underwent emergent right heart catheterization with endomyocardial biopsy that revealed acute transplant rejection. Unfortunately, given the advanced stage of his infection coupled with transplant rejection, palliative care was consulted, and the patient was discharged to hospice. Conclusions: This is the 21st reported case of CNS Fusariosis. Of the reported cases, skin lesions were the most common presenting symptom (52.4%). Altered mental status was the most common neurologic symptom (23.8%). The cerebral cortex was the most frequently involved brain region involved (33.3%). Despite aggressive treatment, the mortality rate is extremely high (9.5%). We recommend a high index of suspicion and aggressive treatment for CNS Fusariosis given its heterogenous presentation, increasing number of reported cases, and fulminant disease course.