title: Rapid progression and unusual premortal diagnosis of mucormycosis in patients with hematologic malignancies: analysis of eight patients.
abstract: Mucormycosis is a rare but emerging group of life-threatening opportunistic mycoses. We described experience of eight patients who developed mucormycosis. These patients had developed hematologic malignancies, and none achieved complete remission. Six of the eight patients presented with neutropenia, five received corticosteroid, and four had concomitant hyperglycemia. The most frequent physical finding was fever, and five patients complained of facial pain, headache, or chest pain. Four patients presented with concomitant bacterial infection, pulmonary aspergillosis, or intestinal candidiasis. Premortal diagnosis of mucormycosis was made in only one patient. Postmortem biopsy or autopsy was the diagnostic tool for the other patients. Although patients who were treated with amphotericin B survived longer than those treated with micafungin or voriconazole, all patients died due to the progression of mucormycosis. Estimated median survival was 23 days. Premortal diagnosis was rarely achieved as biopsy of infected tissues was the only diagnostic tool, and four patients who revealed dual infection were diagnosed with aspergillosis or bacterial infections. In patients with a high risk of mucormycosis presenting with pain and uncontrollable fever, mucormycosis should be included in the differential diagnosis. High dosages of liposomal amphotericin B should be given and surgical debridement should be performed promptly in cases highly suggestive of mucormycosis.
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan. yano@jikei.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Yano
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Minami
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kaichi
authors.initials: K
authors.lastname: Nishiwaki
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Shimada
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Dobashi
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yahagi
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takei
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Takahara
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Ogasawara
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Katsuki
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kinuyo
authors.initials: K
authors.lastname: Kasama
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Tomohito
authors.initials: T
authors.lastname: Machishima
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Katsube
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Usui
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi Shinbashi Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Aiba
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D001706:Biopsy; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D009503:Neutropenia / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D011743:Pyrimidines / Q000008:administration & dosage*; D012189:Retrospective Studies; D015996:Survival Rate; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole