Siriwardena Pradeep, Wariyapperuma Ushani, Nanayakkara Pasindu, Jayawardena Naamal, Mendis Dhanushka, Bahar Milhan, Somawardana Buddhika
National Cancer Institute, Maharagama, Sri Lanka.
Department of Physiology, Faculty of Medicine, University of Moratuwa, Moratuwa, Sri Lanka.
BMC Infect Dis. 2024 Dec 26;24(1):1465. doi: 10.1186/s12879-024-10334-y.
Mucormycosis, is a rare yet potentially life-threatening fungal infection common in immunocompromised patients. Despite optimal care, mucormycosis in haemato-oncological patients often results in poor outcomes. This case series details the presentations and unique challenges faced during the management of patients with acute myeloid leukemia who developed rhino-cerebral mucormycosis.
We present three cases of rhino-cerebral mucormycosis in patients with acute myeloid leukemia: two females aged 35 and 29, and one male aged 42. Symptoms manifested during chemotherapy induction, with all patients experiencing symptoms suggestive of rhino, orbital, or cerebral infection in a background of severe neutropenia (ANC < 0.5). Nasal endoscopy revealed necrotic tissue in all cases, with contrast-enhanced computer tomography (CECT) confirming invasive fungal infection. Rhizopus species were isolated in cultures from the two female patients, and histopathological evidence of fungal invasion was noted in one. Prompt treatment with liposomal Amphotericin B combined with surgical debridement with functional endoscopic sinus surgery (FESS) and treatment of neutropenic sepsis resulted in the survival of two patients, though one succumbed during treatment.
This case series highlights the importance of early clinical suspicion and treatment of mucormycosis in hematological malignancies. Due to mild and atypical presentations and lack of confirmation by microbiological and histological methods, a multifaceted diagnostic approach combining clinical, laboratory, and imaging modalities is essential. A multidisciplinary treatment approach with the management of concomitant complications like neutropenic sepsis is crucial for better outcomes.
毛霉病是一种罕见但可能危及生命的真菌感染，在免疫功能低下的患者中较为常见。尽管给予了最佳治疗，但血液肿瘤患者的毛霉病往往预后不佳。本病例系列详细介绍了急性髓系白血病患者发生鼻脑型毛霉病时的临床表现及治疗过程中面临的独特挑战。
我们报告了3例急性髓系白血病患者发生鼻脑型毛霉病的病例：2名女性，年龄分别为35岁和29岁，1名男性，年龄为42岁。症状出现在化疗诱导期，所有患者在严重中性粒细胞减少（中性粒细胞绝对值<0.5）的背景下均出现提示鼻腔、眼眶或脑部感染的症状。鼻内镜检查在所有病例中均发现坏死组织，增强计算机断层扫描（CECT）证实为侵袭性真菌感染。从2名女性患者的培养物中分离出根霉属真菌，其中1例有真菌侵袭的组织病理学证据。及时给予脂质体两性霉素B治疗，联合功能性鼻内镜鼻窦手术（FESS）进行手术清创以及治疗中性粒细胞减少性败血症，2例患者存活，尽管有1例在治疗期间死亡。
本病例系列强调了血液系统恶性肿瘤中早期临床怀疑和治疗毛霉病的重要性。由于临床表现轻微且不典型，以及缺乏微生物学和组织学方法的确诊，采用临床、实验室和影像学多方面相结合的诊断方法至关重要。采用多学科治疗方法并处理中性粒细胞减少性败血症等伴随并发症对于取得更好的治疗效果至关重要。
