Sudden death in a patient with bone marrow transplant by a fungus among us.
Mucormycosis is rare, presenting as breakthrough infection among haematological and transplant patients on prophylaxis with voriconazole. We report an unusual presentation of this infection, that which is pneumonia progressing to cardiac arrest. A 68-year-old woman with refractory acute myelogenous leukaemia on voriconazole prophylaxis was initially admitted for neutropenic fever and pneumonia. She was discharged improved on antibiotics and voriconazole for presumed aspergillosis. She returned after 1 month with the same presentation. She eventually improved on antibiotics and voriconazole, and eventually received bone marrow transplantation. Three days later, she developed pleuritic chest pain, dyspnoea, and hypoxia requiring intubation. An hour after intubation, the patient arrested and expired. Autopsy revealed Rhizopus pneumonitis with pulmonary infarction, and emboli to her cerebellum, heart, thyroid and kidney. Mucormycosis is an emerging, fatal infection that should be suspected in haematological and transplant patients who deteriorate on voriconazole.
Department of Infectious Diseases, Washington University in St. Louis/ Barnes-Jewish Hospital, St Louis, Missouri, USA.
Lemuel
L
Non
Department of Pulmonary and Critical Care, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Joanna Paula
JP
Sta Cruz
Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Sherilyn
S
Tuazon
D000368:Aged; D001707:Biopsy, Needle; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods; D003645:Death, Sudden; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy; D009091:Mucormycosis / Q000175:diagnosis* / Q000188:drug therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014057:Tomography, X-Ray Computed / Q000379:methods