title: Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma-Case Report and Review of Literature.
abstract: Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Chermetz
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Gobbo
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Rupel
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ottaviani
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Tirelli
authors.affiliation: UCO Pathological Anatomy and Histopathology Unit, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Bussani
authors.affiliation: Infectious Diseases Unit, University Hospital, Trieste, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Lenarda
authors.affiliation: Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy. m.biasotto@fmc.units.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Biasotto
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D060085:Coinfection / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005910:Glioma / Q000150:complications / Q000628:therapy; D006651:Histocytochemistry; D006801:Humans; D008279:Magnetic Resonance Imaging; D008437:Maxilla / Q000000981:diagnostic imaging / Q000473:pathology; D008853:Microscopy; D009091:Mucormycosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D012008:Recurrence; D013280:Stomatitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B
keywords: Aspergillosis; Early diagnosis; Invasive fungal infection; Mucormycosis