Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy.
Mediterr J Hematol Infect Dis. 2013 Jul 10;5(1):e2013048. doi: 10.4084/MJHID.2013.048. Print 2013.
Mucormycosis is the third cause of invasive mycosis after candidiasis and aspergillosis in AML patients, representing a poor prognostic factor associated with a high rate of fatal outcome. We report a case of a patient with AML and a concomitant pulmonary mucormycosis at diagnosis, who obtained a complete remission both of her AML and of the fungal infection. The incidence of the infection at the onset of leukemia is extremely unusual, and, to our knowledge, the sporadic cases reported in the literature are included in heterogeneous series retrospectively examined. In our case, Liposomal Amphotericin B as single agent appeared incapable of controlling the infection, so anti-infective therapy was intensified with posaconazole and simultaneously antileukemic treatment with 5-azacitidine was started, with the understanding that the only antifungal treatment would not have been able to keep the infection under control for a long time if not associated with a reversal of neutropenia related to the disease. We observed a progressive improvement of the general conditions, a healing of pneumonia and a complete remission of the leukemic disease, suggesting that a careful utilization of the new compounds available today, in terms of both antifungal and antileukemic treatment, may offer a curative chance a patient who would have otherwise been considered unfit for a potentially curative therapeutic strategy.
毛霉菌病是 AML 患者侵袭性真菌感染的第三大病因，仅次于念珠菌病和曲霉菌病，是与高病死率相关的不良预后因素。我们报告了 1 例 AML 患者在确诊时同时合并肺部毛霉菌病，该患者 AML 和真菌感染均获得完全缓解。在白血病发病时发生感染的发生率极为罕见，据我们所知，文献中报道的散发病例均包含在回顾性检查的异质系列中。在我们的病例中，两性霉素 B 脂质体作为单一药物似乎无法控制感染，因此抗真菌治疗采用泊沙康唑强化，并同时开始用 5-氮杂胞苷进行抗白血病治疗，我们的理解是，如果不伴随疾病相关的中性粒细胞减少症得到逆转，仅使用抗真菌治疗将无法长期控制感染。我们观察到患者的一般状况逐渐改善，肺炎愈合，白血病完全缓解，这表明，在抗真菌和抗白血病治疗方面，谨慎使用当今可用的新型化合物可能为原本被认为不适合潜在治愈性治疗策略的患者提供治愈机会。
