Faculty Bibliography

Beta-D-glucan (BDG) testing can expedite the diagnosis of invasive fungal infections in immunocompromised hosts. Elevated BDG levels have been reported in both in-vitro studies assessing cross-reactivity with Nocardia spp. and published cases of patients with nocardiosis, but there is little data on this association in solid organ transplantation (SOT) recipients. To explore this association, we conducted a case series of SOT recipients with culture-proven nocardiosis and BDG testing who received their care at our institution between 2016 and 2021. We found thirteen cases of nocardiosis in SOT recipients, of which three cases met our case definition of an elevated BDG. Their clinical courses are detailed in the present report. We found that BDG may be elevated in SOT with nocardiosis with no identified cause of false positive BDG, though a causal association cannot be determined. Future prospective studies that better evaluate the association between nocardiosis and BDG are warranted, as are studies that better characterize the possible variability in reactivity amongst Nocardia spp.

Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, we present the case of a 60-year-old Lebanese man with newly diagnosed acute myeloid leukaemia who developed oesophageal mucormycosis after induction chemotherapy with idarubicin/cytarabine (7+3). The diagnosis was made when the patient developed febrile neutropenia and odynophagia. CT scan of the chest revealed a thickened oesophagus. Oesophagogastroduodenoscopy with biopsy, histopathology and PCR were performed, resulting in the diagnosis of Rhizopus microsporus The patient was successfully treated with liposomal amphotericin B and salvage posaconazole therapy without surgical intervention. We reviewed the clinical characteristics of the six published oesophageal mucormycosis reports from the literature.