A neutropenic leukaemia patient on voriconazole prophylaxis develops fever, sinusitis and multiple painful necrotic skin lesions over the limbs. Two sets of blood cultures grow a mould with septate hyphae and abundant sickle-shaped (banana-shaped) macroconidia. The most likely organism is:
- A Aspergillus flavus
- B Lomentospora prolificans
- C Fusarium solani ✓
- D Scedosporium apiospermum
Correct answer: C. Fusarium solani
Explanation
Fusarium solani uniquely among the hyaline moulds is recovered from blood cultures in disseminated disease, because it forms adventitious sporangiole-like structures allowing haematogenous dissemination of spores, and it causes painful metastatic skin lesions in profound neutropenia. Aspergillus almost never grows in blood culture despite similar skin findings, which distinguishes it. The sickle or banana-shaped macroconidia are the morphological signature of Fusarium on microscopy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.