Invasive fusariosis after CD19 chimeric antigen receptor T-cell therapy

ABSTRACT Background Invasive fusariosis is rarely reported post-chimeric antigen receptor T-cell (CAR-T) therapy. We herein present a case of cutaneous invasive Fusarium infection and provide a compilation of similar cases documented in the existing literature. Case Summary A 61-year-old woman with relapsed refractory diffuse large B-cell lymphoma and secondary hemophagocytic lymphohistiocytosis received CD19-CAR-T therapy. She developed grade 1 cytokine release syndrome (CRS) and grade 3 immune effector cell-associated neurotoxicity syndrome (ICANS), requiring dexamethasone and anakinra. Twenty-five days after CAR-T, she developed bilateral proximal thigh nodular lesions. Skin biopsy revealed hyphal structures with hyphal structures, and culture revealed Fusarium species. Treatment with liposomal amphotericin B, voriconazole, and terbinafine followed by voriconazole and terbinafine led to clinical improvement. Conclusion Though rare, healthcare providers should maintain an index of suspicion for Fusarium infections in recipients of cellular therapies with risk factors.