Case Report. Successful outcome of invasive nasal sinus zygomycosis in a child with relapsed acute lymphoblastic leukaemia due to liposomal amphotericin B

Abstract

We report a case of life-threatening nasal sinus zygomycosis that developed during remission induction therapy for a relapsed acute lymphoblastic leukaemia. The patient was successfully treated with liposomal amphotericin B and granulocyte-colony stimulating factor followed by surgical reconstruction of the resultant cutaneous defect.

Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child

“…zygomycosis in childhood acute lymphoblastic leukaemia. Eur J Pediatr 160: 235-238 [15] a Day 1 is the first day of fever or appearance of local signs subsequently shown to be the focus of zygomycosis…”

Curación de mucormicosis rinocerebral en un paciente pediátrico con leucemia activa

“…No fue considerado el empleo de anfotericina liposomal por estar fuera de alcance presupuestario en nuestra institución pues representa un gasto cercano a US 300.00 diarios. Con anfotericina liposomal hay reportes terapéuticos exitosos en mucormicosis atribuidos al uso de mayores dosis diarias de anfotericina: 5-10 mg/kg 5,6 . Entre los nuevos antifúngicos desarrollados, posaconazol y ravuconazol exhiben in vitro en reportes preliminares actividad sobre Rhizopus con CIM 50 de 1-2 µg/ml y esperan ser evaluados clínicamente en esta afección 7 .…”

Successful treatment with UVA rush hardening in a case of solar urticaria

“…The lesions may appear red and indurated but often progress to form black eschars. The liposomal form of amphotericin B (AmBisome ® ; Gilead Sciences, Foster City, CA, USA) is associated with fewer side-effects and offers dramatically better outcomes [4]. This disease often causes necrotic hemorrhagic lesions because Mucor species have an ability to invade the walls of vessels and proliferate, causing thrombosis and subsequent infarction of the involved vessel, with subsequent local tissue destruction [1,7,8].…”

“…We believe the present case represented secondary hematogenous spread from a pulmonary site to the skin because pulmonary involvement was clinically evident before the appearance of skin lesions, and microbiological cultures from BAL also identified the presence of the genus Mucor. The poor prognosis in this infection is mainly due to a failure to achieve early diagnosis, extensive involvement and the underlying condition [4]. Given the poor prognosis, mucormycosis usually requires several simultaneous modes of therapy: surgical debridement; antifungal therapy; and improvement of immunosuppressive state [1,2].…”

“…The symptoms are usually observed within ten minutes after exposure to sunlight. Due to resistance to the common treatments, the patient was treated with UVA rash hardening therapy, according to previous reports, with a small modification [3,4]. SU is commonly treated with oral antihistamines, sunscreen, plasmapheresis and/or immunosuppressants.…”