Fatal Rhizopus Infections in Hemodialysis Patients Receiving Deferoxamine

Abstract

Four hemodialysis patients receiving deferoxamine for metal overload had fatal rhinocerebral rhizopus infections. Serious fungal infections are not commonly seen in patients on dialysis, and none of these patients had the usual risk factors for rhizopus infection. Deferoxamine is being used with increased frequency in dialysis patients for aluminum and iron overload states. We propose that there is a link between the deferoxamine therapy and this unusual infection. Deferoxamine may serve as a specific growth factor for Rhizopus species or may alter host immune function. We suggest searching for fungal organisms in patients with unexplained illnesses receiving deferoxamine.

Mucormycosis: association with deferoxamine therapy

“…Although the first dialysis patient with mucormycosis, reported by Gluskin et al [17], was not noted to be receiving deferoxamine, subsequent cases of mucormycosis in patients undergoing dialysis have been in those receiving deferoxamine for aluminum or iron excess [6][7][8][9][10][11][12][13]15]. In addition to patients with renal failure, patients with hematologic disorders, all of whom were treated with deferoxamine, have been reported with mucormycosis [3][4][5]14,16].…”

“…The mean age was 49.6 years, with a range from 28 to 70 years. Of those cases in which the organism was identified, Rhizopus species occurred in 13 [6,10,11,15,16] and Cunninghamella bertholletiae in three [4,5,t4].…”

“…Chronic renal disease requiring maintenance hemodialysis was present in 20 of the 26 patients (77%) [6][7][8][9][10][11][12][13]15], whereas the remaining six patients had hema- tologic disorders requiring frequent transfusions [3][4][5]14,16]. Four patients, two with renal failure and two with hematologic disorders, had undergone splenectomy previously [5,7,10,14].…”

“…Only one patient each had diabetes mellitus [4], corticosteroid therapy [15], or chemotherapy [5]. The indications for deferoxamine therapy were iron overload (nine patients) [3][4][5]8,11,13,14,16,current case], aluminum overload (14 patients) [6,[8][9][10][11]15], and both iron and aluminum excess (three patients) [7,10,12]. All patients with aluminum excess were undergoing hemodialysis.…”

“…A new association, that of mucormycosis occurring in patients receiving deferoxamine therapy for iron or aluminum excess, has been reported with increasing frequency since 1986 [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Although this association has been strongly linked with chronic renal failure requiring hemodialysis, it is now clear that other conditions in which deferoxamine may be required (thalassemia, sideroblastic anemia, myelodysplasia) are also associated with mucormycosis [5,7,8,16].…”