Recurrent Rhino-Ocular-Cerebral Mucormycosis in a Leukemic Child: A Case Report and Review of Pediatric Literature

Abstract

Mucormycosis is an uncommon but severe fungal infection, typically observed in immunocompromized patients. We report a case of acute lymphoblastic leukemia complicated by rhino-oculo-cerebral mucormycosis in a pediatric patient. Combination lipid polyene-echinocandin therapy, along with surgical debridement appeared to be effective. Nevertheless, a severe relapse occurred during posaconazole prophylaxis; antifungal therapy, hemimaxillectomy and suspension of chemotherapy were performed. Although mucormycosis is a frequently lethal infection, prompt diagnosis and aggressive treatment can be successful even in cases of relapse.

Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

“…Additional supportive therapy includes iron chelators, caspofungin and hyperbaric oxygen [11]. Although, the standard antifungal therapy is parenteral infusion of amphotericin B but it has a disadvantage of prolonged hospitalization and need for regular monitoring because of its significant side effects [12]. Injection site allergic reaction requires administration of diphenhydramine [12].…”

“…Although, the standard antifungal therapy is parenteral infusion of amphotericin B but it has a disadvantage of prolonged hospitalization and need for regular monitoring because of its significant side effects [12]. Injection site allergic reaction requires administration of diphenhydramine [12]. Hence there was a need of alternative medication with minimal side effects and equal efficacy.…”

Aggressive Combined Medical and Surgical Management of Mucormycosis Results in Disease Eradication in 2 Pediatric Patients

“…It is an aggressive, opportunistic infection caused by organisms of Mucorales order and Zygomectes class. [1][2][3] It frequently progresses to involve the orbit and cerebrum. 4,5 Mucormycosis is commonly associated with immunocompromised patients, uncontrolled diabetes mellitus, chronic steroid use, lymphoma, leukemia, AIDS, and organ transplantation.…”

“…4,5 Mucormycosis is commonly associated with immunocompromised patients, uncontrolled diabetes mellitus, chronic steroid use, lymphoma, leukemia, AIDS, and organ transplantation. [1][2][3][4][5][6][7][8] Signs of infection are nonspecific but may include acute sinusitis, erythema over the sinuses, fever, periorbital edema, ptosis, proptosis, dark nasal, and/or palatine mucosal eschar. 2,5 The pathological hallmark is invasion of blood vessel walls, thrombus formation, infarction of surrounding tissue, and black necrosis.…”

“…2,5 The pathological hallmark is invasion of blood vessel walls, thrombus formation, infarction of surrounding tissue, and black necrosis. 1,4,9 Patients with locally invasive sinus mucormycosis have a mortality rate of 47% to 85%. 6,8,10,11 Cerebral extension in immunocompromised patients is almost universally fatal with a rapid, fulminant progression and a reported median survival of 17 to 39 days.…”