Oral Mucormycosis and Aspergillosis in the Patient with Acute Leukemia

Abstract

A 54-year-old male patient with acute lymphoblastic leukemia was referred to the Department of Oral Medicine. He had a primary refractory disease and was treated according to HOVON71 and HAM protocol. Sixteen days after the start of the HAM protocol the patient developed palatal dark red/brownish lesion and maxillary vestibular exophytic lesion. Biopsy specimens from oral lesions were taken and microbiologic evaluation confirmed the presence of Aspergillus fumigatus and Rhizopus genus. The treatment of the patient consisted of the inferior maxillectomy and intravenous posaconazole and amphotericine B for the following 28 days. Since the coinfection with Aspergillus and Rhizopus is extremely rarely seen in the oral cavity, a diagnostic and therapeutic dilemma easily presents itself.

Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection in a patient with diabetes mellitus: A case report

“…Mucormycosis and aspergillosis are two opportunistic and IFIs that have clinical and para-clinical similarities. They are rarely associated and their diagnosis is challenging, often misleading practitioners [ [2] , [3] , [4] , [5] ]. These severe infections could be disseminated involving multiple organs and are frequently fatal in immunocompromised patients [ 1 , 2 , 4 , 7 ].…”

“…They are rarely associated and their diagnosis is challenging, often misleading practitioners [ [2] , [3] , [4] , [5] ]. These severe infections could be disseminated involving multiple organs and are frequently fatal in immunocompromised patients [ 1 , 2 , 4 , 7 ]. This coinfection have commonly been described in patients with hematologic malignancies and severe neutropenia [ 2 , 7 ].…”

“…Mucormycosis and aspergillosis are the most frequent fungal infections caused by ubiquitous filamentous fungi [ 1 ]. Coinfection in the same host is scarce and has a poor prognosis [ [2] , [3] , [4] , [5] ]. It commonly affects immunocompromised patients.…”

Fungal Infections of Oral Cavity: Diagnosis, Management, and Association with COVID-19

“…The most commonly identified species from cases of aspergillosis is Aspergillus fumigatus, followed by Aspergillus flavus, Aspergillus niger , and Aspergillus terreus . Aspergillosis affects individuals in immunosuppressive states and those with bone marrow transplantation in hematological malignancies [ 33 ]. Life-threatening complications can occur in immunocompromised patients with aspergillosis [ 4 ].…”

“…Mucormycosis primarily affects immunocompromised, bone marrow–transplanted, hematological malignancies, or poorly controlled diabetic individuals [ 33 ]. Rhizopus is the chief pathogenic mycotic organism in cases with rhinocerebral mucormycosis.…”