Serio B, Rosamilio R, Giudice V, Zeppa P, Esposito S, Fontana R, Annunziata S, Selleri C
Hematology, Pathology and Infectious Disease Branch, Department of Medicine, University of Salerno, Italy.
Infez Med. 2012;20 Suppl 2:43-7.
Mucormycosis is an increasingly recognized invasive fungal infection (IFI) in patients with acute myeloid leukemia (AML) and after allogeneic (allo) stem cell transplantation (HSCT); it is mainly due to the severe and prolonged neutropenia related to high-dose chemotherapy. In such patients, the lung is the most frequently involved site in mucormycosis. Since rapidly progressive dissemination may occur after pulmonary mucormycosis in hematologic malignancies, early diagnosis and prompt initiation of an effective antifungal therapy is mandatory for a successful outcome. We report the case of a young AML patient who developed, early after the onset of neutropenia in the first induction phase of chemotherapy, a rapidly progressive pulmonary IFI, successfully treated with liposomal Amphotericin-B (LAmB) and then with a limited open toracothomy biopsy, clearly establishing diagnosis of mucormycosis and removing lung infiltrate. Secondary prophylaxis with LamB, applied during both consolidation therapy and myeloablative sibling allogeneic HSCT, was effective to prevent IFI recurrence despite the development of grade I acute graft-versus-host disease (GVHD) and limited chronic GVHD requiring immunosuppressive treatment. Our case report further provide evidence that the combined surgical and LAmB therapy is an effective and safe choice for the management of pulmonary mucormycosis in hematological immunocompromised patients.
毛霉菌病是急性髓系白血病（AML）患者和异基因（allo）干细胞移植（HSCT）后一种越来越被认识到的侵袭性真菌感染（IFI）；这主要归因于与高剂量化疗相关的严重且持续时间长的中性粒细胞减少。在这类患者中，肺部是毛霉菌病最常累及的部位。由于血液系统恶性肿瘤患者发生肺毛霉菌病后可能会迅速出现播散，因此早期诊断并迅速开始有效的抗真菌治疗对于取得成功的治疗结果至关重要。我们报告了一例年轻的AML患者，在化疗第一个诱导期出现中性粒细胞减少后不久，发生了快速进展的肺部IFI，先用脂质体两性霉素B（LAmB）成功治疗，随后进行了有限的开胸肺活检，明确诊断为毛霉菌病并清除了肺部浸润灶。在巩固治疗和清髓性同胞异基因HSCT期间应用LAmB进行二级预防，尽管出现了I级急性移植物抗宿主病（GVHD）且慢性GVHD有限需要免疫抑制治疗，但仍有效预防了IFI复发。我们的病例报告进一步证明，手术和LAmB联合治疗是血液系统免疫功能低下患者肺部毛霉菌病管理的一种有效且安全的选择。
