Sommers Schwartz attorney John Malone filed a medical malpractice lawsuit for a 41-year-old man with acute myeloid leukemia (AML) whose oncologist failed to prescribe standard antifungal prophylaxis to prevent a mold-based fungal infection during high-dose chemotherapy. That failure allowed a devastating and preventable fungal infection to take hold in an immunocompromised patient.
In late October 2023, the plaintiff presented to a Port Huron-area hospital emergency department with low hemoglobin and was admitted for evaluation of pancytopenia, a condition in which red blood cells, white blood cells, and platelets are all abnormally low. A hematology/oncology consult the following day identified concerns for AML, and a bone marrow biopsy confirmed the diagnosis on November 1, 2023. The plaintiff was then transferred to inpatient care at the same facility for placement of a central intravenous line and initiation of high-dose chemotherapy.
Before chemotherapy began, the plaintiff’s oncologist prescribed fluconazole as antifungal prophylaxis, the purpose being to prevent fungal infections during the period of profound immune suppression that accompanies AML treatment. The problem: fluconazole does not protect against Aspergillus, a mold-based fungal pathogen that poses a well-recognized and serious risk to patients with AML undergoing chemotherapy. The standard of care for immunocompromised AML patients requires prophylaxis with posaconazole or a similarly effective mold-active agent. Fluconazole covers yeast but not mold, and this distinction is not obscure medical knowledge — it is a fundamental consideration in the care of this patient population.
Over the following weeks, the plaintiff was hospitalized multiple times for complications, including neutropenic fever, facial cellulitis, sepsis, and a deep vein thrombosis (DVT). By late January 2024, he was transferred to a Detroit cancer center, where an infectious disease specialist immediately recognized a highly concerning picture: the plaintiff had been on fluconazole for months while remaining deeply immunocompromised, and his facial swelling, nasal symptoms, and imaging findings raised urgent alarm for invasive fungal sinusitis caused by Aspergillus or a similar organism. The specialist noted that the patient’s face was “highly concerning” for an angioinvasive fungal process and documented: “This is very bad situation.” Emergency antifungal therapy and surgical intervention were initiated.
Between February and March 2024, the plaintiff underwent five separate surgical procedures to remove necrotic (dead) bone and tissue from his sinuses, including an anterior septectomy, partial rhinectomy, removal of portions of his hard palate and maxillary bone, and multiple endoscopic debridements. He remained hospitalized from January 30 to March 9, 2024. He subsequently received a stem cell transplant in July 2024 and has been in remission from AML since that time. However, the invasive Aspergillus infection and the surgeries required to treat it left him with a saddle nose deformity, a persistent oronasal fistula (an abnormal opening between the mouth and nasal cavity), and significant permanent disfigurement to his face. Because his prior work involved proximity to excavated soil, an environment in which Aspergillus is commonly found, he has also been forced to change his employment.
Had the standard of care been followed and the plaintiff been placed on a mold-active prophylactic agent, such as posaconazole, at the outset of his chemotherapy, the invasive aspergillosis infection would have been prevented or substantially mitigated.
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