Combined antifungal therapy, iron chelation and surgical resection as treatment of hepatic zygomycosis in a patient with haematological malignancy.
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.
Busca
Alessandro
A
Marmont
Filippo
F
Locatelli
Franco
F
Limerutti
Giorgio
G
Sorrentino
Maria Teresa
MT
Barbui
Anna
A
Patrono
Damiano
D
Salizzoni
Mauro
M
David
Ezio
E
De Rosa
Francesco
F
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
D000935:Antifungal Agents; D007502:Iron Chelating Agents