[Invasive pulmonary mucormycosis with invasion of the thoracic spine in a patient with myelodysplastic syndrome].
We report the case of a 67-year-old patient who presented with a myelodysplastic syndrome and who developed a pulmonary mucormycosis with a rare extension to the dorsal spine. A decompressive laminectomy was attempted after failure of broad-spectrum antifungal treatment (Cancidas, V-Fend). The diagnosis was obtained after surgical biopsy. The scheduled lobectomy could not be performed because of altered clinical condition. The patient eventually died despite adapted antifungal treatment (Abelcet, Posaconazole). Pulmonary mucormycosis is a rare cause of mycotic infection that reaches most of the time immunocompromised patients. The pathogenic agent is part of zygomyces that have angio-invasive ability. Perineural propagation was recently described. Immunodepression, late diagnosis and lack of response to new generation antifungal drugs (V-Fend, Cancidas) are responsible for therapeutic failure in this disease. This case emphasizes the risk inherent to empirical antifungal treatment and the need of early biopsy in cases that do not respond to treatment.
De Pasqual
A
A
Université de Liège.
Deprez
M
M
Ghaye
B
B
Frère
P
P
Kaschten
B
B
Hayette
M P
MP
Radermecker
M
M
Martin
D
D
Canivet
J L
JL
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D007796:Laminectomy; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D009091:Mucormycosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013122:Spinal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013904:Thoracic Vertebrae; D014230:Triazoles / Q000627:therapeutic use
D000935:Antifungal Agents; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B