Mucormycosis during Imatinib treatment: case report.
Philadelphia chromosome positive acute lymphoblastic leukemia is classified as a very high-risk group and it requires an intensive chemotherapy regimen associated with tyrosine-kinase inhibitors and allogeneic hematopoietic stem cell transplant from related or unrelated HLA matched donor. Most times, intensive chemotherapy regimens are associated with prolonged and profound pancytopenia when the risk of invasive fungal infection increases. After Candida and Aspergillus species, Mucormycosis is the third frequent fungal infection in hematology patients and it is associated with a reduced overall survival. When suspected, immediate treatment is needed. We present the case of 24-year-old patient diagnosed with Philadelphia chromosome positive acute lymphoblastic leukemia who developed right rhino-sino-orbital fungal infection with a favorable response to systemic antifungal treatment and noninvasive surgery. Later, patient refused consolidation and allogeneic hematopoietic stem cell transplant from an unrelated HLA matched donor but accepted the first generation tyrosine kinase inhibitor (Imatinib) and maintained a complete hematological and molecular response.


BACKGROUND
ENT = ear nose throat; BMB = bone marrow biopsy; ALL = acute lymphoblastic leukemia; TKI = tyrosine kinase inhibitor; IFI = invasive fungal infection; BMB = bone marrow biopsy; HE = hematoxylin and eosin; IHC = immunohistochemistry; CD = cluster of differentiation; ob = objective; Tdt = terminal deoxynucleotidyl transferase.
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
A M
AM
Crisan
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
A
A
Ghiaur
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
M C
MC
Stancioaca
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
A
A
Bardas
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
C
C
Ghita
ENT & HNS Department, "Sfanta Maria" Hospital, Bucharest, Romania.
C M
CM
Manea
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
B
B
Ionescu
Centre of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania ; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
D
D
Coriu
D001853:Bone Marrow / Q000473:pathology; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D009091:Mucormycosis / Q000150:complications / Q000188:drug therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
Philadelphia chromosome; invasive fungal infection; tyrosine kinase inhibitor