Successful management of cerebral and pulmonary mucormycosis with liposomal amphotericin B in a 28-year-old woman with acute lymphoblastic leukemia.
A 28-year-old woman with acute lymphoblastic leukemia developed fever and unilateral pleural based pulmonary infiltrate during prolonged chemotherapy induced neutropenia. CT-guided lung biopsy confirmed the diagnosis of pulmonary mucormycosis and liposomal amphotericin B therapy was started. A few days after the initial symptoms, the patient developed convulsions and a brain abscess was detected in computerized tomography and magnetic resonance imaging. Fungal hyphae detected in histopathological examination of a brain biopsy had identical morphology with those seen in previous lung biopsies. The patient was treated with liposomal amphotericin B for five months and cytotoxic chemotherapy was successfully completed during antifungal therapy. Pulmonary infiltrates and the brain abscess resolved and the patient received an allogeneic bone marrow transplantation from a matched, unrelated donor. Antifungal therapy was continued for one additional month after bone marrow transplantation to prevent a relapse of invasive mucormycosis. Follow-up of the patient revealed no signs of relapse of invasive mucormycosis but two months after successful bone marrow transplantation the patient developed lethal cytomegalovirus pneumonitis which was confirmed by autopsy. No signs of mucormycosis were detected at post-mortem.
Salonen
Juha H
JH
Department of Internal Medicine, Turku University Central Hospital, Turku, Finland. juha.h.salonen@phks.fi
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D001922:Brain Abscess / Q000188:drug therapy* / Q000209:etiology; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003586:Cytomegalovirus Infections / Q000150:complications; D003630:Daunorubicin / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008081:Liposomes; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000209:etiology; D015122:Mercaptopurine / Q000008:administration & dosage; D008942:Mitoxantrone / Q000008:administration & dosage; D009091:Mucormycosis / Q000188:drug therapy* / Q000209:etiology; D011024:Pneumonia, Viral / Q000150:complications; D011183:Postoperative Complications / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D012074:Remission Induction; D014184:Transplantation, Homologous; D014750:Vincristine / Q000008:administration & dosage
D000935:Antifungal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D000666:Amphotericin B; D003520:Cyclophosphamide; D008942:Mitoxantrone; D015122:Mercaptopurine; D001215:Asparaginase; D003630:Daunorubicin