title: Combined antifungal therapy, iron chelation and surgical resection as treatment of hepatic zygomycosis in a patient with haematological malignancy.
abstract: We describe the case of a 19-year-old boy with acute leukaemia who developed primary hepatic zygomycosis. The patient presented with febrile neutropenia and severe abdominal tenderness. Despite the administration of antibiotics and liposomal Amphotericin-B (L-AmB), the CT scan demonstrated an increase in the size of liver lesions. A wide surgical resection was carried out and liver specimens demonstrated a branching, filamentous fungus that was identified as Rhizomucor pusillus by both phenotypic and molecular methods. The patient was treated with L-AmB combined with posaconazole, and deferasirox was subsequently added given the potential synergistic effect of this iron chelator in combination with L-AmB. Three months after surgical intervention, an allogeneic stem-cell transplantation was successfully carried out. The present case confirms that an early surgical management combined with antifungal agents is crucial to optimise the outcome of patients with zygomycosis and the use of deferasirox is a promising alternative.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Filippo
authors.initials: F
authors.lastname: Marmont
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Limerutti
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Sorrentino
authors.forename: Anna
authors.initials: A
authors.lastname: Barbui
authors.forename: Damiano
authors.initials: D
authors.lastname: Patrono
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Ezio
authors.initials: E
authors.lastname: David
authors.forename: Francesco
authors.initials: F
authors.lastname: De Rosa
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D003646:Debridement; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D007938:Leukemia / Q000150:complications*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008107:Liver Diseases / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D008297:Male; D011859:Radiography; D020103:Rhizomucor / Q000302:isolation & purification*; D014054:Tomography; D016896:Treatment Outcome; D055815:Young Adult; D020096:Zygomycosis / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000935:Antifungal Agents; D007502:Iron Chelating Agents