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

• 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
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2013-009577

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.