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

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

Author address: 

University Hospital Merkur (Zagreb, HR)

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.
2011

abstract No: 

P820

Full conference title: 

Annual Meeting of the EBMT, 37th
    • EBMT 37th (2011)