A 4-year-old child with leukemia and an enlarging arm lesion

• Published in: Canadian Medical Association journal (CMAJ) 2005-02, Vol.172 (3), p.332-332
• Main Authors: Mater, Ahmed, Al-Sulaiti, Ghada, Johnston, Donna L, Slinger, Robert
• Format: Article
• Language: English
• Subjects: Arm; Bandages - adverse effects; Care and treatment; Child, Preschool; Humans; Injuries; Leukemia in children; Male; Mucormycosis - diagnosis; Mucormycosis - etiology; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - complications; Rhizopus - isolation & purification
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.1041231

A 4-year-old boy was admitted to hospital with a diagnosis of pre-B-cell acute lymphoblastic leukemia. Ten days later, he experienced fever, neutropenia and a lesion on the lateral aspect of his left arm just above the elbow. The purplish lesion was 1 cm in diameter and was not painful. The child was given piperacillin and gentamicin, but the lesion increased in size and became necrotic. Ecthyma gangrenosum due to disseminated bacterial infection was initially suspected. However, a skin biopsy revealed wide, aseptate fungal hyphae, consistent with an agent of mucormycosis. The infected site had been under adhesive tape that was used to secure an intravenous catheter, removed several days before, in the antecubital fossa. CT examinations showed that the patient's chest and sinuses were normal, and the child was clinically well. Primary cutaneous mucormycosis was felt to be the probable diagnosis. Therapy with amphotericin B was started and then changed to 5 mg/kg of amphotericin B lipid complex per day because of renal impairment. The lesion, which had continued to enlarge, was fully excised.