title: Lessons from a case of oromandibular mucormycosis treated with surgery and a combination of amphotericin B lipid formulation plus caspofungin.
abstract: 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.
authors.affiliation: Département d'Hématologie, Hôpital E. Muller, Mulhouse Cedex, France. ojedam@evhr.net
authors.forename: Mario
authors.initials: M
authors.lastname: Ojeda-Uribe
authors.forename: Raoul
authors.initials: R
authors.lastname: Herbrecht
authors.forename: Marie Hélène
authors.initials: MH
authors.lastname: Kiefer
authors.forename: Philippe
authors.initials: P
authors.lastname: Schultz
authors.forename: Jorge
authors.initials: J
authors.lastname: Chain
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Chenard
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Servant
authors.forename: Christian
authors.initials: C
authors.lastname: Debry
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D000077336:Caspofungin