Case report: Ganoderma weberianum Invasive Fungal Disease (IFD) during allogeneic haematopoietic stem cell transplantation (HSCT).

Scott, Ashleigh P; Choptiany, Markian; Dwyer, Jennifer; McCarthy, Kate L

A 62 year old man underwent matched unrelated donor (MUD) HSCT, using fludarabine-based conditioning, for the treatment of myelodysplastic syndrome (MDS). Primary antifungal prophylaxis was fluconazole 200mg daily. During neutrophil engraftment, he developed high fevers and productive cough. Computed tomography (CT) chest imaging demonstrated scattered small solid tree-in-bud pulmonary nodules, in the right upper lobe and bilateral lower lobes, with associated ground-glass halo sign (Figure 1a), suspicious for pulmonary IFD. Bacterial cultures from blood and sputum were non-contributory. Bronchoalveolar lavage (BAL) was recommended, but could not be performed initially due to the active local restrictions on bronchoscopy during the first wave of the COVID19 pandemic. Staging did not reveal any other potential sites of cutaneous or internal IFD.