Abstract
We report a 38-year-old woman presenting with febrile neutropenia, acute myeloid leukemia (AML) and invasive mucormycosis. Bone marrow aspirate was characteristic of AML minimally differentiated (WHO classification 2008). Flow cytometric immunophenoty** analysis showed blasts positive for CD7, CD33, CD34, CD71, CD117, HLA-DR, MPO, and TdT, with normal karyotype (46, XX), and the absence of the FLT3-ITD and NPM1 mutations. The patient’s management included chemotherapy with cytarabine and idarubicin, and treatment with liposomal amphotericin B, deferasirox, hyperbaric oxygen therapy, and antibiotics. Nowadays, she is in complete hematological remission, and CT images of control are normal. Invasive mucormycosis is an uncommon and severe condition, which involves diagnosis and treatment challenges. Clinical features and predisposing factors should be highlighted in order to enhance the suspicion index, contributing to early diagnosis and disease control. Our aim is to report classical features of this uncommon condition and to emphasize usual management challenges.
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References
Kivivuori SM, Karikoski R, Koukila-Kähkölä P, Anttila VJ, Saarinen-Pihkala UM. Zygomycosis presenting a major clinical challenge: case report on Rhizomucor pusillus infection in a stem-cell-transplant recipient. Mycopathologia. 2011;172(3):241–5.
Nawange SR, Singh SM, Naidu J, Jain S, Nagpal T, Behrani DS, et al. Zygomycosis caused by Rhizopus microsporus and Rhizopus oryzae in Madhya Pradesh (M.P.) Central India: a report of two cases. Mycopathologia. 2012;174(2):171–6.
Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood. 2011;118(5):1216–24.
Marques AS, Camargo RMP, Abbade LPF, Marques MEA. Mucormicose: infecção oportunística grave em paciente imunossuprimido. Relato de caso. Diagn Tratamento. 2010;15(2):64–8.
Pagano L, Offidani M, Nosari A, Candoni A, Piccardi M, Corvatta L, et al. Mucormycosis in hematologic patients. Haematologica. 2004;89(2):207–14.
Spellberg B, Walsh TJ, Konyoyannis DP, Edwards J Jr, Ibrahim AS. Recent advances in the treatment of mucormycosis: from bench to bedside. Clin Infect Dis. 2009;48(12):1743–51.
Täger FM, Zaror CL, Martínez DP. Cutaneous mucormycosis in an immunocompromised patient. Rev Chilena Infectol. 2012;29(1):101–7.
Karthaus M, Hentrich M. Wait and see or rush and switch? New questions for the management of patients with febrile neutropenia receiving antifungal prophylaxis. Mycoses. 2011;54(Suppl 1):1–6.
Lin SY, Lu PL, Tsai KB, Lin CY, Lin WR, Chen TC, et al. A mucormycosis case in a cirrhotic patient successfully treated with posaconazole and review of published literature. Mycopathologia. 2012;174(5–6):499–504.
Ribeiro LC, Wanke B, da Silva M, Dias LB, Mello R, Canavarros FA, et al. Mucormycosis in Mato Grosso, Brazil: a case reports, caused by Rhizopus microsporus var. oligosporus and Rhizopus microsporus var. rhizopodiformis. Mycopathologia. 2012;173(2–3):187–92.
Zavrelová A, Matejková A, Nová M, Hoffmann P, Buchta V, Zák P. Case 3–2011: invasive mucormycosis (zygomycosis) after bone marrow transplantation in a 26-year-old man with relapsing acute myeloid leukaemia. Acta Medica. 2011;54(4):163–6.
Gompelman D, Heussel CP, Schuhmann M, Herth FJF. The role of diagnostic imaging in the management of invasive fungal disease—report from an interactive workshop. Mycoses. 2011;54(Suppl 1):27–31.
Segal E, Menhusen MJ, Simmons S. Hyperbaric oxygen in the treatment of invasive fungal infections: a single-center experience. Isr Med Assoc J. 2007;9(5):355–7.
Horger M, Hebart H, Schimmel H, Vogel M, Brodoefel H, Oechsle K, et al. Disseminated mucormycosis in haematological patients: CT and MRI findings with pathological correlation. B J Radiol. 2006;79(945):e88–95.
Casal M, Linares MJ, Solis F, Rodriguez FC. Appearance of colonies of Prototheca on CHROMagar Candida medium. Mycopathologia. 1997;137(2):79–82.
Ricciardi AM, Ricciardi R, Danzi M, Mungiguerra M, Pisano L, Marino A. In vitro activity of voriconazole and other antifungal agents against clinical isolates of 138 Candida spp. Infez Med. 2009;17(1):24–7.
Grandesso S, Sapino B, Mazzucato S, Solinas M, Bedin M, D’Angelo M, et al. Study on in vitro susceptibility of Candida spp. isolated from blood culture. Infez Med. 2012;20(1):25–30.
Shoham S, Magill SS, Merz WG, Gonzalez C, Seibel N, Buchanan WL, et al. Primary treatment of zygomycosis with liposomal amphotericin B: analysis of 28 cases. Med Mycol. 2010;48(3):511–7.
Moen MD, Lyseng-Williamson KA, Scott LJ. Liposomal amphotericin B: a review of its use as empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections. Drugs. 2009;69(3):361–92.
Gonzales CE, Couriel DR, Walsh TJ. Disseminated zygomycosis in a neutropenic patient: successful treatment with amphotericin B lipid complex and granulocyte colony-stimulating factor. Clin Infect Dis. 1997;24(2):192–6.
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Ribeiro, E.F.O., dos Santos, V.M., Paixão, G.T.G. et al. Mucormycosis in a Patient with Acute Myeloid Leukemia Successfully Treated with Liposomal Amphotericin B Associated with Deferasirox and Hyperbaric Oxygen. Mycopathologia 175, 295–300 (2013). https://doi.org/10.1007/s11046-013-9629-0
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DOI: https://doi.org/10.1007/s11046-013-9629-0