Successful treatment of disseminated mucormycosis in a neutropenic patient with T-cell acute lymphoblastic leukaemia

Abstract

Mucormycosis is a rare angioinvasive fungal infection, more commonly seen in immunosuppressed patients, with reported mortality rates of 95% in disseminated disease. We present a case report of a patient with T-cell acute lymphoblastic leukaemia who developed disseminated infection with mucormycosis (involving the pancreas, left occipital lobe, right lower lobe of lung, appendix and right kidney) after having completed induction and consolidation chemotherapy. Growth ofLichtheimia corymbiferawas initially isolated following a right pleural tap with fungal elements identified repeatedly on subsequent pathology specimens. Following radical surgical debridement and concurrent treatment with combination antifungal therapy, the patient survived. This case demonstrates that aggressive multisite surgical de-bulking of disseminated fungal foci, in conjunction with combination antifungal therapy and reversal of immunosuppression, can result in survival despite the grave prognosis associated with disseminated mucormycosis.

Bacteriome and mycobiome associations in oral tongue cancer

“…The fact that tumor samples exhibited decrease in abundance of Emericella could suggest that the corresponding increase in Campylobacter , Fusobacterium and Porphyromonas may be happening concomitantly as the levels of Lichtheimia (the fungus Mucor ) are increasing. Lichtheimia is associated with infections in immunocompromised (including cancer) patients [ 30 - 33 ], while the bacterial genera Fusobacterium and Porphyromonas (known periodontal pathogens) and Campylobacter (common in GI infections) are major constituents of the “mobile microbiome” originating in the oral cavity but also associated with extra-oral infections and inflammation [ 34 ]. The correlations observed in the current study with oral tongue cancer patients may indicate that microbial dysbiosis reflects changes in the immune status due to the underlying disease.…”

Isavuconazole in a Successful Combination Treatment of Disseminated Mucormycosis in a Child with Acute Lymphoblastic Leukaemia and Generalized Haemochromatosis: A Case Report and Review of the Literature

“…The most significant risk factors are: prolonged neutropenia, former broad-spectrum antibiotic therapy and diabetes including steroid-induced [4]. Review of the paediatric pulmonary mucormycosis reports published since 2010 based on PubMed and Cochrane databases showed that mucormycosis risk factors were: neutropenia (61.5% patients), broad-spectrum antibiotic therapy (35%), previous treatment with voriconazole (31%) and diabetes (27%) (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. A total of 26 patients were identified: 19 children suffered from haematological disease, 5 had diabetes, one had osteosarcoma and one was diagnosed after a neardrowning incident.…”

Mucormycoses caused by Lichtheimia species

“…Endobronchial bleeding is typical for pulmonary mucormycosis but not specific for Lichtheimia infections. Pulmonary Lichtheimia infections can disseminate to different internal organs, including the central nervous system, often associated with fatal outcome . Pathological alterations resemble those observed in other cases of mucormycosis and are characterised by vascular invasion, thrombosis and tissue necrosis.…”