Objective:

Fusarium infections are rarely-reported but significant complications in immunocompromised patients, particularly those undergoing chemotherapy and bone marrow transplantation. Neurological involvement in fusariosis is uncommon, highly fatal, and poses a diagnostic and therapeutic challenge. 

Background:

Case Presentation: We report a case of a 76-year-old Caucasian male with myelodysplastic syndrome treated with chemotherapy, who subsequently underwent a bone marrow transplant. The patient presented with generalized weakness, memory impairment, and episodic confusion. Blood cultures were positive for Fusarium species, and punch biopsy of skin lesions confirmed disseminated fusariosis.
Interventions: The patient was initially treated with liposomal amphotericin B, followed by posaconazole. After he showed only a partial response to initial treatments, fusomanogepix, a novel antifungal agent, was added to the regimen due to persistent infection. 
Outcome: The patient's neurological symptoms gradually improved with the combination therapy, and follow-up cultures indicated resolution of the fusariosis. However, he exhibited persistent memory impairment and required prolonged antifungal therapy and close monitoring due to the risk of recurrence. 

Design/Methods:

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Results:

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Conclusions:

This case highlights the complexity of managing disseminated fusariosis with neurological involvement in immunocompromised patients. Early recognition, comprehensive diagnostic workup, and aggressive, multifaceted antifungal therapy are critical for improving survival and functional outcomes. Further research is needed to establish standardized treatment protocols for such challenging cases.