Disseminated Pulmonary with Isolated Muscular Mucormycosis in an Acute Myeloid Leukemia Patient: A Case Report and Literature Review

Fadhel, Mustafa; Patel, Swapnil; Liu, Edward; Fune, Lito; Wasserman, Ethan; Asif, Arif

doi:10.12659/ajcr.916864

Cited by 7 publications

(3 citation statements)

References 37 publications

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“…However, some cases are reported outside India. 22 Triple COVID wave has left healthcare workers encumbered and overwhelmed but management of mucormycosis in post COVID second wave was really challenging for medical professionals. But due to the increased awareness and advances in diagnostic techniques, many patients were managed efficiently.…”

Section: Discussionmentioning

confidence: 99%

Changing faces and habitat of mucormycosis epidemic in sequential COVID waves

Tyagi

Grover²,

Bansal³

2022

IJPO

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The Corona virus poses a greater challenge in the form of the deadly fungal infection, mucormycosis. To study the histopathological features giving emphasis on the varying presentation of mucormycosis in sequential covid waves.A prospective study comprising 31 patients histopathologically diagnosed with mucormycosis were included in the study. Demographic features, predisposing conditions, and clinical features were obtained from medical records. Tissue sections were reviewed with hematoxylin and eosin (H and E), and special stains like Gomori's methenamine silver (GMS), and periodic acid Schiff (PAS) potassium hydroxide (KOH) examination and fungal culture. The study included 21 males and 10 females with age ranging from 35-75 years. On histopathological examination, inflammation, granulomas, foreign body giant cells along with necrosis was seen. Invasion into soft tissues, muscles, and adipose tissues along with Angioinvasion, perineural spread was identified. Fungal balls, round to ovoid mature sporangia with column-shaped columella, presence of proliferating hyphae in tissues like skeletal muscle, cartilage etc which are supposed to be relatively resistant for inflammatory pathology got noted as one of our astounded histopathological findings insinuating how a human body acts as a culture media exhibiting diversity of a human makeup. The trend of presentation and severity kept changing with successive covid wave. Diagnosis of mucormycosis is gruesome and more difficult as compared to other infectious organism. In addition, like any malignant pathology, perivascular and neural infiltration is one of the important histological features of invasive mucormycosis as it indicates the severity and prognosis. There is drastically different trend of presentation in covid and its different mutant waves.

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Section: Discussionmentioning

confidence: 99%

Changing faces and habitat of mucormycosis epidemic in sequential COVID waves

Tyagi

Grover²,

Bansal³

2022

IJPO

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“…Mucormycosis, caused by opportunistic pathogenic fungi that belong to the order Mucorales, commonly occurs in immunosuppressed patients with hematological diseases after chemotherapy or hematopoietic stem cell transplantation (HSCT) with a high mortality rate ( Kontoyiannis et al., 2005 ; Roden et al., 2005 ; Petrikkos et al., 2012 ). The use of prophylactic and therapeutic drugs, such as glucocorticoids, immunosuppressants, and broad-spectrum antibiotics, has become an important pathogenic factor for mucormycosis infection in patients with acute leukemia, with pulmonary involvement being the most common presentation ( Fadhel et al., 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Mucor indicus caused disseminated infection diagnosed by metagenomic next-generation sequencing in an acute myeloid leukemia patient: A case report

Shen

Li²,

Baker³

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundMucormycosis commonly occurs in immunosuppressed patients with hematological diseases, which can be life-threatening. However, many cases are often misdiagnosed due to lack of specific clinical manifestations. Additionally, the traditional blood culture or serological testing, with a high false-negative rate, is time-consuming. Thus, precise and timely diagnosis of infections is essential for the clinical care of infected patients.Case presentationWe report a 29-year-old Chinese man with acute myeloid leukemia (AML) who developed febrile neutropenia after the first course of induction chemotherapy. He received empirical antibiotics, which did not relieve his symptoms. No pathogen was detected by traditional microbiologic assays, while Mucor indicus was identified by metagenomic next-generation sequencing (mNGS) in the blood specimen. Liposomal amphotericin B (LAmB) was used, resulting in the patient’s temperature returning to normal. A few days later, abdominal computed tomography (CT) scan showed multiple liver abscesses; fluorescence staining, histopathology, and mNGS identified the causative agent—M. indicus. Posaconazole was combined with LAmB as long-term antifungal treatment. Finally, the patient received allogeneic hematopoietic stem cell transplantation successfully after controlled infection. During follow-up 1 year after transplantation, the number of liver abscesses was reduced to one and remained stable.ConclusionThis report described the first case of an AML patient diagnosed with culture-negative disseminated infections caused by M. indicus leading to rare hepatic manifestations using mNGS of peripheral blood and liver biopsy. LAmB combined with posaconazole was given in time, resulting in a favorable outcome. mNGS is a new method that assists in detecting the probable pathogen and increases the accuracy of identifying an etiology.

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“…[ 2 ] The most common clinical presentations are rhino-orbital-cerebral followed by pulmonary, gastrointestinal, cutaneous, and disseminated. [ 3 4 ] Isolated tracheal and cerebral mucormycosis have also been reported. [ 5 6 ] Mucormycosis disease has a high mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Challenges in the Management of Rhino-Orbital Cerebral Mucormycosis

Bhalerao

Kuttarmare

Joshi

et al. 2022

Anesthesia Essays &Amp; Researches

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Background: Coronavirus disease 2019 (COVID-19) pandemic is the biggest threat of the century. Associated with this disease, are a number of rhino orbital cerebral mucormycosis cases seen as post COVID sequelae. Amphotericin B and surgical debridement are the treatment modalities. Aims: This study aimed to describe the clinical characteristics and perioperative outcomes of patients with ROCM. Settings and Design: This was a prospective, observational study. Materials and Methods: We carried out a study of 238 patients with confirmed ROCM posted for functional endoscopic sinus surgery, craniotomies, maxillofacial surgeries, and orbital exenteration under general anesthesia and the perioperative challenges therein. Statistical Analysis Used: Data were entered in the excel sheet. Descriptive statistics were used to summarize the data. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 27:0. Categorical variables were expressed as counts and percentages. Results: 78% had diabetes mellitus, 64% had received steroids, 59% had a preoperative oxygen saturation of less than 90%, 86% had a 4–6 zone involvement on chest radiograph, and more than 50% had an anticipated difficult airway. Postsurgery, 13% of patients required intensive care. The 15-day mortality rate was 3% among the operated cases. Conclusion: Post-COVID ROCM is challenging in terms of preoperative poor general condition, difficult airway, intraoperative concerns due to pathophysiology of the disease and its effect on organ systems, and the requirement of postoperative vigilant monitoring.

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Disseminated Pulmonary with Isolated Muscular Mucormycosis in an Acute Myeloid Leukemia Patient: A Case Report and Literature Review

Cited by 7 publications

References 37 publications

Changing faces and habitat of mucormycosis epidemic in sequential COVID waves

Changing faces and habitat of mucormycosis epidemic in sequential COVID waves

Mucor indicus caused disseminated infection diagnosed by metagenomic next-generation sequencing in an acute myeloid leukemia patient: A case report

Perioperative Challenges in the Management of Rhino-Orbital Cerebral Mucormycosis

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