title: Pulmonary mucormycosis with embolism: two autopsied cases of acute myeloid leukemia.
abstract: Mucormycosis is an increasingly important cause of morbidity and mortality for patients with hematological malignancies. The diagnosis of mucormycosis usually requires mycological evidence through tissue biopsy or autopsy because the signs and symptoms are nonspecific and there are currently no biomarkers to identify the disease. We herein present two autopsied cases of acute myeloid leukemia with prolonged neutropenia who developed invasive mucormycosis accompanied by pulmonary artery embolism. Our cases were featured by unexplained fever and rapidly progressive dyspnea. Computed tomography scan detected nodular lesions or nonspecific consolidations in the lungs. Cultures, cytological study, and serum fungal markers consistently gave negative results. Autopsy revealed embolism of the pulmonary artery which consisted of fibrin clots by filamentous fungi. Genomic DNA was extracted from the paraffin-embedded clots and was applied to polymerase chain reaction amplification, leading to the diagnosis of infection by Rhizopus microsporus. We should carefully search for life-threatening pulmonary embolism when patients with hematological malignancies develop pulmonary mucormycosis.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kogure
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Shinozaki-Ushiku
authors.affiliation: Medical Mycology Research Center, Chiba University Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Medical Mycology Research Center, Chiba University Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kamei
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo Japan.
authors.forename: Tetsuichi
authors.initials: T
authors.lastname: Yoshizato
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Nannya
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo Japan ; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital Japan.
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001344:Autopsy; D016026:Bone Marrow Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D009091:Mucormycosis / Q000150:complications* / Q000276:immunology / Q000473:pathology; D011655:Pulmonary Embolism / Q000209:etiology* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents
keywords: Rhizopus microsporus; acute myeloid leukemia; mucormycosis; neutropenia; pulmonary embolism