title: Successful management of pulmonary mucormycosis with liposomal amphotericin B and surgery treatment: a case report.
abstract: Mucormycosis is an increasingly recognized invasive fungal infection (IFI) in patients with acute myeloid leukemia (AML) and after allogeneic (allo) stem cell transplantation (HSCT); it is mainly due to the severe and prolonged neutropenia related to high-dose chemotherapy. In such patients, the lung is the most frequently involved site in mucormycosis. Since rapidly progressive dissemination may occur after pulmonary mucormycosis in hematologic malignancies, early diagnosis and prompt initiation of an effective antifungal therapy is mandatory for a successful outcome. We report the case of a young AML patient who developed, early after the onset of neutropenia in the first induction phase of chemotherapy, a rapidly progressive pulmonary IFI, successfully treated with liposomal Amphotericin-B (LAmB) and then with a limited open toracothomy biopsy, clearly establishing diagnosis of mucormycosis and removing lung infiltrate. Secondary prophylaxis with LamB, applied during both consolidation therapy and  myeloablative sibling allogeneic HSCT, was effective to prevent IFI  recurrence despite the development of grade I acute graft-versus-host disease (GVHD) and limited chronic GVHD requiring immunosuppressive treatment. Our case report further provide evidence that the combined surgical and LAmB therapy is an effective and safe choice for the management of pulmonary mucormycosis in hematological immunocompromised patients.
authors.affiliation: Hematology, Pathology and Infectious Disease Branch, Department of Medicine, University of Salerno, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Serio
authors.forename: R
authors.initials: R
authors.lastname: Rosamilio
authors.forename: V
authors.initials: V
authors.lastname: Giudice
authors.forename: P
authors.initials: P
authors.lastname: Zeppa
authors.forename: S
authors.initials: S
authors.lastname: Esposito
authors.forename: R
authors.initials: R
authors.lastname: Fontana
authors.forename: S
authors.initials: S
authors.lastname: Annunziata
authors.forename: C
authors.initials: C
authors.lastname: Selleri
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D009091:Mucormycosis / Q000188:drug therapy* / Q000601:surgery*; D012074:Remission Induction
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B