gms | German Medical Science

Introduction: Geotrichum capitatum is an uncommon but frequently fatal cause of sepsis in neutropenic patients. We report a case of Geotrichum sepsis in an adult patient with refractory acute lymphoblastic leukemia undergoing salvage chemotherapy.

Case report: We admitted a 44 year old patient with a relapsed mature T-cell acute lymphoblastic leukemia in March 2012. During the neutropenic phase following salvage chemotherapy, the patient developed a severe infection of unknown origin with fever, hypotension, confusion and acute renal failure. Investigations including abdominal ultrasound and high resolution thorax CT revealed multiple liver lesions and severe pulmonary infiltrates respectively. Due to the poor general condition of the patient and a severe coagulopathy, we were unable to perform a liver biopsy or a bronchoalveolar lavage. Multiple cultures of blood, stool and urine were taken and empiric broad spectrum therapy with Cefepime, Linezolid, Amphotericin B and Acyclovir was started. Shortly after starting treatment the patient developed upper GI bleeding and an upper GI endoscopy was performed. Findings revealed multiple yellow esophageal plaques and multiple erosions in the stomach and duodenum.

Diagnostic work-up took eight days for stool cultures and four days for blood cultures respectively to reveal Geotrichum capitatum as the causative pathogen. During this period of time the patient was transferred to our intermediate care unit were he required high doses of inotropes. After confirmation of diagnosis the antifungal therapy was escalated by increasing the dose of Amphotericin B and adding high dose Posaconazole. Despite treatment, the patients’ condition rapidly deteriorated and six days after confirmed microbiological diagnosis the patient died. The postmortem examination of the GI tissue samples revealed widespread evidence of fungal hyphae, consistent with Geotrichum capitatum, retrospectively confirming the diagnosis of Geotrichum sepsis.

Discussion: Infections caused by Geotrichum capitatum are extremely rare, but incidence has increased in patients with hematological malignancies during the last decades [1], [2]. Patients with acute leukemia and those who undergo salvage therapy, are at particular risk due to prolonged periods of neutropenia from previous therapies as was the case with our patient [6], [2]. Disseminated infections of Geotrichum capitatum are associated with an unfavorable outcome and a high mortality rate [3], [5]. This is due to a combination of difficult diagnosis and poor response to treatment [4]. At present there is no recommended standard therapy but in view of the increasing incidence of Geotrichum capitatum more research on this topic is warranted.