(549) When Trauma Met Fungus: A Surprising Case of Fusarium Infection

Introduction: Fusarium species are opportunistic fungi commonly associated with plant pathology but can also infect humans, particularly in immunocompromised hosts. However, localized Fusarium infections are infrequent in immunocompetent individuals, and even rarer following polytrauma. This case report details an unusual instance of a young polytrauma patient who developed a localized Fusarium infection.

Description: A 21-year-old male with no significant medical history presented to the emergency department following a motor vehicle accident. The patient sustained multiple injuries, including an open fracture of the left humerus. He underwent several surgical procedures and was subsequently managed in the intensive care unit.

The patient developed worsening leucocytosis and persistent fever, despite broad-spectrum antibiotic therapy. Initial cultures, including blood and sputum, were negative for infection. On postoperative day 10, after the removal of the wound vacuum from his upper extremity surgical site, a moderate volume of brackish fluid was expressed and sent for culture. Two days later, preliminary culture results indicated the presence of mold, initially suspected to be a contaminant. However, the patient's clinical condition deteriorated, and further debridement and washout of the left upper extremity wound were performed with tissue cultures revealing the presence of mold Fusarium.

Isavuconazole was added to the treatment regimen. However, the patient remained febrile with persistent leucocytosis. The antifungal susceptibility testing revealed multidrug-resistant Fusarium species. Consequently, antifungal therapy was escalated to a combination of amphotericin B and voriconazole. The patient's fever and leucocytosis gradually improved and he was eventually discharged to a long-term acute care facility.

Discussion: Invasive fusariosis is a rare but potentially fatal condition, particularly challenging to diagnose and manage. In polytrauma patients presenting with persistent fever despite broad-spectrum antibiotic therapy, fungal infections such as fusariosis should be considered in the differential diagnosis. This case report underscores the evolving epidemiology of fungal infections and emphasizes the critical need to initiate empiric antifungal therapy in such patients.