Rhinocerebral mucormycosis in a transplanted patient with relapsed acute lymphoblastic leukaemia: a case report

Ref ID: 18628

Author:

A. Ostojic, H. Minigo, D. Radic-Kristo, Nj. Gredelj, B. Jaksic,
R. Vrhovac

Author address:

University Hospital Merkur (Zagreb, HR)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Background: Mucormycosis is a rare and serious opportunistic
infection caused by fungi of the order Mucorales, predominantly
seen in immunocompromised patients. Ketoacidosis, neutropenia, steroid therapy and hematological malignancies are the
main factors making one susceptible to this infection. In majority of cases clinical presentation is rhinocerebral mucormycosis
and, if not diagnosed promptly and treated adequately, outcome can be fatal. We present a patient with this rare fungal
infection, previously treated with allogeneic hematopoietic stem
cell transplantations.
Case report: A 37 year old woman was admitted in our center
because of 4th relapse of her acute lymphoblastic leukemia
(ALL) (Table 1). For this relapse she received combination
chemotherapy and anti-infective prophylaxis (Table 2). Ten
days following chemotherapy she became febrile. Microbiological cultures, cytological smears and Galactomannan tests were
done repeatedly, but did not reveal the cause of infection. She
remained febrile despite several lines of empirical antimicrobial
therapy. CT-scan of lungs showed a nodal leason in the lower
right lobe suggesting possible aspergillosis, so voriconazole
was added, but without clinical improvement. After patient
started to complain of nasal congestion, left upper jaw teeth-pain
and left facial paresthesia, with left facial edema, nasopharinx
swab was done and Rhizopus oryzae was isolated. CT-scan of
paranasal sinuses showed mucosal infi ltration in left paranasal
sinuses without signs of intracranial progression. Due to low
platelets, surgical treatment of this invasive fungal infection was
contraindicated and treatment with amphotericin B (amB) colloidal dispersion was initiated. On this therapy patient started to
improve clinically and soon thereafter became afebrile. After 6
weeks on amB, she was remarkably better, with marked radiological regression of rhinocerebral mucormycosis.
Conclusion: In spite a number of adverse factors such as ALL,
neutropenia, diabetes mellitus, steroid therapy, the outcome of
treatment in this patient was favorable. We conclude that close
clinical follow-up, rapid and targeted diagnostic procedures followed by appropriate antifungal therapy can lead to good clinical
responses, even in transplanted patients with poor prognosis.

Abstract Number: P820

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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