Therapeutic Challenges of Hepatic Mucormycosis in Hematologic Malignancy: A Case Report and Review of the Literature.
Challenging differential diagnosis, Rare disease
Raffaele M. Bernardo, Ananta Gurung, Dhanpat Jain, Maricar F. Malinis
Section of Infectious Diseases, Yale University, School of Medicine, New Haven, CT, CT, USA
Am J Case Rep 2016; 17:484-489
Available online: 2016-07-13
The clinical presentation of mucormycosis can vary widely based on various host factors. Among malignancy- and bone marrow transplant-associated infections, the lungs are the most common site of infection. Involvement of the gastrointestinal tract is less frequently encountered. The clinical presentation is often nonspecific, and cultures typically yield no growth, making the diagnosis challenging.
CASE REPORT: We present a case of isolated hepatic mucormycosis in the setting of neutropenic fever and abdominal pain following induction chemotherapy for the treatment of acute myeloid leukemia. The patient was treated with combination antifungal therapy with amphotericin and posaconazole without surgical resection, given the presence of multiple liver lesions. After a prolonged course of dual antifungal therapy, the size of her liver lesions improved. Unfortunately, her lymphoproliferative disorder proved fatal, following approximately 13 months of antifungal therapy.
CONCLUSIONS: Among patients with mucormycosis, mortality remains high, especially in the setting of gastrointestinal involvement. Although surgical resection along with dual antifungal therapy can improve outcomes, the high mortality rate necessitates further investigation into improved diagnostic and treatment strategies including optimal antifungal therapy.
Keywords: Chemotherapy, Adjuvant - adverse effects, Antifungal Agents - therapeutic use, Amphotericin B - therapeutic use, Fatal Outcome, Female, Humans, Immunocompromised Host, Leukemia, Myeloid, Acute - complications, Liver Diseases - microbiology, Middle Aged, Mucormycosis - etiology, Risk Factors, Treatment Failure, Treatment Outcome, Triazoles - therapeutic use