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Fatal Disseminated Pythium insidiosum Infection in a Child With Diamond-Blackfan Anemia

Schloemer, Nathan J. MD*; Lincoln, Anne H. MD; Mikhailov, Theresa A. MD, PhD*; Collins, Chelsea L. MD; Di Rocco, Jennifer R. MD§; Kehl, Sue C. PhD; Chusid, Michael J. MD

Infectious Diseases in Clinical Practice: July 2013 - Volume 21 - Issue 4 - p e24–e26
doi: 10.1097/IPC.0b013e318278f3b5
Case Reports

Abstract: Pythium insidiosum is an oomycete pathogen known to rarely cause invasive infections in humans. Childhood infections are even more unusual, particularly in North America. We recently cared for a 14-year-old girl with fatal disseminated pythiosis who apparently acquired her infection in Texas. Our patient had Diamond-Blackfan anemia, requiring monthly red cell transfusions since infancy with resultant iron overload. She presented with pelvic pain, which progressed to osteomyelitis of multiple pelvic bones followed by vascular invasion and occlusion of bilateral iliac and femoral arteries refractory to anticoagulation, localized tissue plasminogen activator therapy, and surgical embolectomy. Despite administration of a broad range of antibiotic and antifungal therapy, as well as directed immunotherapy, the patient died with disseminated pythiosis. Pythiosis is an unfamiliar pathogen in the United States and extremely difficult to treat, necessitating early diagnosis and urgent medical and surgical intervention when practical for improved prognosis.

From the *Section of Pediatric Critical Care; †Pediatrics; ‡Section of Pediatric Hematology/Oncology; §Section of Pediatric Hospitalist Medicine; ∥Division of Microbiology and Pathology of Pediatrics and Pathology; and ¶Section of Pediatric Infectious Disease, Departments of Pediatrics and Pathology, Children’s Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI.

Correspondence to: Nathan J. Schloemer, MD, Section of Pediatric Critical Care, 9000 W Wisconsin Ave, MS 681, Milwaukee, WI 53226. E-mail: nschloem@mcw.edu.

The authors have no funding or conflicts of interest to disclose.

All authors have contributed to the manuscript in significant ways and have reviewed and agreed on the manuscript’s content.

© 2013 by Lippincott Williams & Wilkins.