ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
First report of proven Fusarium brachygibbosum sinusitis in a paediatric patient with acute myeloblastic leukaemia.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeFusarium brachygibbosum is an environmental mould belonging to the Fusarium sambucinum species complex (FSAMSC) and is only exceptionally reported as a human pathogen. Invasive fusariosis is a recognized complication in patients with hematological malignancies; however, proven infection caused by F. brachygibbosum has not previously been described. We report the first case of proven breakthrough sinusitis in a pediatric female with refractory acute myeloblastic leukaemia (AML) receiving posaconazole prophylaxis.
methodsWe describe the clinical presentation, microbiological diagnosis, antifungal susceptibility profile, treatment, and outcome of a 13-year-old neutropenic female with refractory AML who developed invasive fungal sinusitis. Species identification was established by Sanger sequencing of the elongation factor 1-alpha, and antifungal susceptibility testing was performed according to the EUCAST reference method.
resultsComputed tomography revealed extensive paranasal sinus involvement, and direct microscopy of sinus tissue demonstrated hyaline septate hyphae. Culture yielded a mould initially misidentified by MALDI-TOF MS as F. chlamydosporium. Molecular sequencing confirmed F. brachygibbosum. The isolate exhibited elevated Minimal inhibitory concentrations (MICs) to amphotericin B, azoles, echinocandins, and olorofim, while fosmanogepix showed a lower in vitro MIC. Extensive surgical debridement combined with liposomal amphotericin B, voriconazole, and subsequently olorofim was performed. Despite local control of the sinonasal infection and no microbiological or histopathological evidence of dissemination, the patient died 23 days after diagnosis. The death occurred in the context of progressive refractory AML, invasive fungal disease, pulmonary abnormalities, and subsequent neutropenic complications.
conclusionThis report represents the first proven pediatric case of invasive sinusitis caused by F. brachygibbosum (FSAMSC) isolate with higher MICs to classical antifungals. The case highlights the diagnostic limitations of MALDI-TOF MS for rare Fusarium species, the value of molecular identification and antifungal susceptibility testing, and the emergence of environmental moulds breakthrough fungal infections. It also underscores the urgent need for effective novel antifungal agents against resistant Fusarium species.
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