title: Mucormycosis in a patient with acute myeloid leukemia successfully treated with liposomal amphotericin B associated with deferasirox and hyperbaric oxygen.
abstract: We report a 38-year-old woman presenting with febrile neutropenia, acute myeloid leukemia (AML) and invasive mucormycosis. Bone marrow aspirate was characteristic of AML minimally differentiated (WHO classification 2008). Flow cytometric immunophenotyping analysis showed blasts positive for CD7, CD33, CD34, CD71, CD117, HLA-DR, MPO, and TdT, with normal karyotype (46, XX), and the absence of the FLT3-ITD and NPM1 mutations. The patient's management included chemotherapy with cytarabine and idarubicin, and treatment with liposomal amphotericin B, deferasirox, hyperbaric oxygen therapy, and antibiotics. Nowadays, she is in complete hematological remission, and CT images of control are normal. Invasive mucormycosis is an uncommon and severe condition, which involves diagnosis and treatment challenges. Clinical features and predisposing factors should be highlighted in order to enhance the suspicion index, contributing to early diagnosis and disease control. Our aim is to report classical features of this uncommon condition and to emphasize usual management challenges.
authors: Onco-Hematology Division, Armed Forces Hospital, Brasília, DF, Brazil. eduardo.flavio@uol.com.br
authors: Eduardo Flavio Oliveira
authors: EF
authors: Ribeiro
authors: Vitorino Modesto
authors: VM
authors: dos Santos
authors: Guilherme Teixeira Guimarães
authors: GT
authors: Paixão
authors: Leonardo Rodrigues
authors: LR
authors: Cruz
authors: Milena Zamian
authors: MZ
authors: Danilow
authors: Vinicius Ferreira
authors: VF
authors: Campos
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D001565:Benzoates / Q000008:administration & dosage*; D001853:Bone Marrow / Q000473:pathology; D000077588:Deferasirox; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D016130:Immunophenotyping; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D009091:Mucormycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D000090243:Nucleophosmin; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*
chemical_list: D000935:Antifungal Agents; D001565:Benzoates; C000716967:NPM1 protein, human; D014230:Triazoles; C068538:liposomal amphotericin B; D000090243:Nucleophosmin; D000666:Amphotericin B; D000077588:Deferasirox