Pediatria pre prax 1/2020

Mucormycosis as a life-threatening complication in patients with acute leukemia

Invasive fungal infections (IFI) are a life-threatening complication of treatment in immune-compromised, especially haemato- oncological, patients. Mucormycosis is the third leading cause of IFI following Aspergillus and Candida species. The first clinical symptoms are usually non-specific and thus may result in delayed diagnosis and treatment. Purpose: The objective of this report is to summarize current literature data about mucormycosis and to present the case of a patient with acute lymphoblastic leukemia who developed this infection in our center. Risk factors for the development of mucormycosis, clinical symptoms, radiologic findings, laboratory results, and outcome are evaluated retrospectively. Case: We describe the case of a 6-year-old female patient with acute lymphoblastic leukemia. During the induction phase of therapy, the patient developed febrile neutropenia and did not respond to the treatment with a combination of antibiotics and supportive therapy. Pansinusitis and orbitocellulitis developed. The etiological agent was identified by examination of the biological material as Rhizopus sp. The patient was treated by a combination of antimycotic drugs, but her condition progressed to the dissemination of the infection to the central nervous system (CNS). She underwent radical surgical resection of affected tissue. At present, still being treated by antimycotic and oncology treatment, her oncologic disease is in remission and her general clinical condition is good. Conclusion: Mucormycosis is an IFI with high morbidity and mortality. Early diagnosis and initiation of effective therapy with the combination of amphotericin B and surgery are necessary to enable a favourable outcome.

Keywords: mucormycosis, acute leukemia, Rhizopus