TABLE 1.

Demographic and clinical findings for 12 patients with proven IFDa

Characteristic(s)Data for patient:
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Gender/age (yr)F/63F/78M/62M/71M/45F/3F/71F/65F/67F/73M/61M/65
Underlying disease(s)RA, DM, COPDDMMMRTCP, AA, Ma, PH, LHS, PDM, RF, HD, CADM, LANHLIM, LARLTAML
Risk factor(s)Steroids, azathioprine, infliximabTopical steroids, cholesteatomaSteroids, VBCMP/VBADSteroids, tacrolimus, mycophenolate mofetil, occupation as gardenerSteroids, EUGCPNSteroids, cyclosporineColonic surgery, postsurgical anastomotic leakagesADOC, steroidsR-CHOP, steroids, PBSCA, neutropenia, traumatic removal of hand nail cuticleTopical steroids, cholesteatomaSteroids, cyclosporineCytarabine, daunorubicin, neutropenia
Clinical syndromeNasal blockage, cephalea, sinusitis (sphenoidal, ethmoidal, and frontal)Earache, ear discharge, mastoiditis, perichondritis, facial palsyCephalea, blindness, convulsive attacks5 mo of painful ankle nodulePain due to CP, cephalea, facial palsySeptic shock, cutaneous nodulesPeritonitisFever, coughingFever, finger pain, cellulitis, proximal onychomycosis5 mo of earache, ear discharge, mastoiditis, perichondritis, facial palsy, cephaleaCephalea, sinusitis (sphenoidal and ethmoidal)Cephalea, earache, ear discharge, mastoiditis, perichondritis, facial palsy
Organ involvement of IFDAbscesses (two frontal brain, sphenoidal, and nasal)Middle ear, mastoidOccipital abscessSubcutaneous tissueBrain abscessesBlood, skinPeritoneal abscessesLungSubcutaneous tissueMiddle ear, mastoid, temporal brain abscessAbscesses (frontal brain and sphenoidal)Middle ear, mastoid, temporal brain abscess
Fungal speciesScedosporium apiospermum clade IVScedosporium apiospermum clade IVScedosporium apiospermum clade IV Alternaria infectoria Cladosporium macrocarpum Fusarium solani Blastoschizomyces capitatus, Candida kefyr Aspergillus fumigatus Aspergillus fumigatus Aspergillus fumigatus Aspergillus versicolor Aspergillus flavus
Site(s) of isolation of fungal speciesSinuses (all) and brainMastoid boneBrainSubcutaneous tissueBrainBlood, nodulesPeritoneal abscessCavitated lung noduleSubcutaneous tissue and nailBrain, mastoid boneSphenoidal and ethmoidal sinusesMastoid bone
HRCT scanAbscesses (two frontal brain, sphenoidal, and nasal), erosion of cribriform plateMastoid bone erosion, demineralization of facial canal, middle ear occupationOccipital abscessNot doneBrain abscessesNot doneAbdominal abscessesCavitated lung nodule in medium right lobuleNot doneMastoid bone erosion, demineralization of facial canal, middle ear occupation, temporal brain abscessNot doneMastoid bone erosion, demineralization of facial canal, middle ear occupation, temporal brain abscess
Baseline serum GM (index)/BG (pg/ml)NA/109NA/109NA/166NA/94NA/71NA/413NA/1,3130.297/4620.927/2470.140/440.144/950.144/347
Monitoring serum GM (index)/BG (pg/ml)Wk 2, NA/67Wk 4, NA/84Wk 2, NA/54; wk 4, NA/72Wk 4, NA/33Wk 2, NA/190; wk 4, NA/72Wk 1, NA/912Wk 1, NA/2,465Wk 1, 0.199/1,277; wk 2, 0.263/1,203Wk 1, 0.540/542; wk 2, 0.383/214; wk 3, 0.460/508; wk 6, 0.231/59Wk 1, 0.90/36; wk 2, 0.166/23; wk 3, 0.235/81; wk 4, 0.185/18; wk 5, 0.373/54; wk 22, 0.13/124Wk 4, 0.284/158Wk 1, 0.168/374; wk 2, 0.945/284; wk 3, 0.589/165
TreatmentVoriconazoleVoriconazole, surgeryVoriconazole, terbinafineItraconazoleVoriconazole, surgeryVoriconazoleLiposomal amphotericin BVoriconazole, caspofunginCaspofunginVoriconazole, caspofungin, surgeryVoriconazole, caspofunginVoriconazole, caspofungin
Clinical outcomeDeathInfection resolvedContinuing infectionInfection resolvedDeathDeathDeathDeathInfection resolvedContinuing infectionDeathDeath
  • a Abbreviations: M, male; F, female; RA, rheumatoid arthritis; DM, diabetes mellitus; COPD, chronic obstructive pulmonary disease; MM, multiple myeloma; RT, renal transplant; CP, chronic pancreatitis; AA, alcohol addiction; Ma, malnutrition; PH, portal hypertension; L, lymphopenia; HS, hemophagocytic syndrome; P, pancytopenia; RF, end-stage diabetes renal failure; HD, hemodialysis; CA, colon adenocarcinoma; LA, lung adenocarcinoma, unknown origin; ADOC, adriamycin, cisplatin, oncovin, cyclophosphamide; NHL, non-Hodgkin's lymphoma; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone; PBSCA, peripheral blood stem cell autologous bone marrow transplant; IM, immunodeficiency (ongoing study); ARLT, acute rejection of liver transplant; AML, acute myelogenous leukemia; EUGCPN, endoscopic ultrasonography-guided celiac plexus neurolysis; VBCMP/VBAD, vincristine, bischloroethylnitrosourea, cyclophosphamide, melphalan, prednisone/vincristine, bischloroethylnitrosourea, adriamycin, dexamethasone; HRCT, high-resolution computed tomography; NA, not applicable.