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

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...

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Bibliographic Details
Published in:BMJ case reports 2013-07, Vol.2013, p.bcr2013009577
Main Authors: Guymer, Chelsea, Khurana, Sanjeev, Suppiah, Ram, Hennessey, Iain, Cooper, Celia
Format: Article
Language:English
Subjects:
Abdomen
Appendicitis
Appendix
Australasia
Chemotherapy
Child
Combined Modality Therapy
Female
Fungal infections
Gallbladder
Histopathology
Humans
Laparoscopy
Medical prognosis
Microscopy
Mortality
Mucormycosis - pathology
Mucormycosis - therapy
Neutropenia - complications
Neutrophils
Ostomy
Pain
Pancreas
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - complications
Pulmonary arteries
Rare Disease
Remission Induction
Surgery
Thrombosis
White
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Summary: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 of Lichtheimia corymbifera was 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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-009577