Mucormycosis is a rare fungal infection that is common amongst uncontrolled diabetics and immunocompromised patients. The most common clinical presentation is rhino-orbital-cerebral infection, which typically affects diabetics with ketoacidosis.1 Less commonly, pulmonary mucormycosis can occur in patients with hematologic malignancy, solid organ transplant and patients taking steroids or deferoxamine.1 The following report describes a 25-year-old male with Acute Myeloid Leukemia (AML) who developed a pulmonary mucormycosis infection. With a mortality rate of about 87%, this case represents a favorable outcome for a rare and often lethal diagnosis.
A 25-year-old male with no past medical history presented to the hospital after two weeks of fatigue, shortness of breath and epistaxis. Lab work revealed leukocytosis with 43% blasts, anemia and thrombocytopenia. A bone marrow biopsy confirmed the diagnosis of AML. After admission, the patient developed persistent fevers and CT scan demonstrated ground-glass opacities in bilateral lung fields. Blood and sputum cultures, respiratory viral panel and acid fast studies were negative and the patient was started on antifungals and broad spectrum antibiotics. Bronchoscopy with bronchoalveolar lavage did not reveal an infectious source. The patient underwent induction chemotherapy with idarubicin and cytarabine, which was initially well tolerated. However, he soon developed neutropenic fever, hypoxia, and a non-productive cough. The treatment was broadened from vancomycin, zosyn and micafungin to meropenem and ambisome. Cultures remained negative during this time and subsequent imaging revealed right-middle and left-upper lobe consolidations with a central lucency.
Pan, MD, Jonathan; Kasner, MD, Margaret; Patel, MD, Sheel; and Diemer, MD, Gretchen
"Pulmonary Mucormycosis in a patient with Acute Myeloid Leukemia,"
The Medicine Forum:
Vol. 16, Article 12.
Available at: http://jdc.jefferson.edu/tmf/vol16/iss1/12