Lessons from a case of oromandibular mucormycosis treated with surgery and a combination of amphotericin B lipid formulation plus caspofungin.
A rare case of oromandibular Rhizopus oryzae infection is described in a 55-year-old woman with acute myeloid leukaemia and decompensated diabetes mellitus. The infection developed during induction chemotherapy when the patient was neutropenic. She was treated with a combination of amphotericin B lipid formulation and caspofungin plus surgery. Debridement surgery included excision of the lower lip, chin, floor of the mouth, a portion of the tongue, as well as mandibular resection at the level of the horizontal branches. Eight weeks of combined antifungal therapy were followed by secondary prophylaxis with amphotericin B lipid formulation during consolidation chemotherapy after achieving complete response of both leukaemia and mucormycosis. Reconstructive surgery was carried out including insertion of a new biomaterial porous mandibular prosthesis, which showed excellent functionality after long-term follow-up, followed by several plastic surgery procedures once good tolerability and no adverse effects of the prosthesis were observed. This case shows that a well-coordinated multidisciplinary approach is critical to increase the chances of clinical success in this life-threatening infection.
Ojeda-Uribe
Mario
M
Département d'Hématologie, Hôpital E. Muller, Mulhouse Cedex, France. ojedam@evhr.net
Herbrecht
Raoul
R
Kiefer
Marie Hélène
MH
Schultz
Philippe
P
Chain
Jorge
J
Chenard
Marie-Pierre
MP
Servant
Jean Marie
JM
Debry
Christian
C
D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D000077336:Caspofungin; D002680:Chin / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D055666:Lipopeptides; D008334:Mandible / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D009091:Mucormycosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D009336:Necrosis; D019651:Plastic Surgery Procedures
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D000077336:Caspofungin