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Detection of Cryptococcus Infection From a Contaminated Autologous Stem Cell Harvest

Highsmith, James MD, MS*; Cheema, Asima MD; Castillo, Elvis MD; Sandin, Ramon L. MD, MS, FCAP§∥; Velez, Ana Paula MD; Greene, John N. MD, FACP¶#

Infectious Diseases in Clinical Practice: January 2012 - Volume 20 - Issue 1 - p 71–74
doi: 10.1097/IPC.0b013e318214b07c
Case Reports

Cryptococcus neoformans infections occur mostly in immunodeficient individuals, including patients with acquired immunodeficiency syndrome, transplant recipients or patients receiving immunosuppressive medication, and patients with hematological malignancies. Although the highest standard of care is taken in preparation for all types of transplantation including hematopoietic stem cell transplantation, the risk of infection and contamination is always present. This case report describes a 63-year-old white man with a history of multiple myeloma, developing asymptomatic cryptococcal fungemia with a nodular pneumonia in association with chemotherapy and self-contaminated infusion of stem cell transplant collection in preparation for an autologous stem cell transplant. Before stem cell infusion, the stem cell collection bag was noted to grow C. neoformans on routine culture. The infusion proceeded with the patient completely informed about the infectious risk of infusing an infected stem cell product. After infusion, he had no fevers, chills, or sweats, and the blood and cerebral spinal fluid cultures remained sterile. In response to the nodular pneumonia noted on the computed tomographic scan of the chest, a bronchoalveolar lavage was performed which grew C. neoformans. The patient was effectively treated with intravenous ambisome and oral 5-flucytosine, followed by a prolonged course of oral fluconazole. This is the first reported case of C. neoformans infected stem cells being infused into a patient. In addition, we review the literature of common contaminants of hematopoietic stem cell collections.

From the *Department of Internal Medicine, †Moffitt Cancer Center, ‡Division of Infectious Diseases and International Medicine, Department of Internal Medicine, §Clinical Microbiology and Virology Laboratories, Moffitt Cancer Center, ∥Pathology and Oncological Sciences, ¶Infectious Diseases, Moffitt Cancer Center and #Internal Medicine and Oncological Sciences, University of South Florida College of Medicine, Tampa, FL.

Reprints: John N. Greene MD, FACP, Moffitt Cancer Center, University of South Florida College of Medicine, 12902 Magnolia Drive, FOB-3, Tampa, Florida 33612-9497. E-mail:

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

© 2012 Lippincott Williams & Wilkins, Inc.