Survival of a Patient With Trauma-Induced Mucormycosis Using an Aggressive Surgical and Medical Approach

Sickels, Nicholas Van; Hoffman, Jordan; Stuke, Lance; Kempe, Kelly

doi:10.1097/ta.0b013e31820784ff

Cited by 20 publications

(15 citation statements)

References 13 publications

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“…We found seventeen cases of isolated hepatic mucormycosis in the literature [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], of which the majority had hematologic malignancy with associated neutropenia and/or cytotoxic chemotherapy. We identified only four cases of isolated hepatic mucormycosis in solid organ transplant recipients, of whom three had liver transplants and one had a kidney transplant ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Isolated Hepatic Mucormycosis in the Early Post-Transplant Period: A Case Report and Literature Review

Santos¹,

Proia²

2019

obm transplant

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Mucormycosis is a rare fungal infection associated with high morbidity and mortality that typically afflicts immunocompromised hosts. We present a case of isolated hepatic mucormycosis with Rhizopus spp. that developed in the early post-transplant period. Initial presentation was concerning for allograft rejection, but definitive diagnosis was made with histopathology and fungal culture. The patient had a favourable outcome with surgical resection, a course of liposomal amphotericin B combined with micafungin, and chronic suppressive therapy with posaconazole. We encountered only four cases of isolated hepatic mucormycosis in solid organ transplant recipients in the literature that presented as either fungal abscess or surgical anastomosis rupture. This case report and literature review demonstrates the need for urgent diagnosis and management of this uncommon condition and outlines an effective therapeutic regimen.

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Section: Discussionmentioning

confidence: 99%

Isolated Hepatic Mucormycosis in the Early Post-Transplant Period: A Case Report and Literature Review

Santos¹,

Proia²

2019

obm transplant

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“…This is a disease condition without many therapeutic options due to the severity of disease. The standard treatment recommended in rhinocerebral mucormycosis is amphotericin B with debridement, but the combined treatment of amphotericin B plus either an echinocandin or an azole with debridement was shown to improve survival in three cases [10,11]. Drugs that have an FDA approved indication for mucormycosis are amphotericin B with its lipid derivatives, and isavuconazonium sulfate, the pro-drug of isavuconazole, which was not available until 2015 (a year after this patient's death).…”

Section: Discussionmentioning

confidence: 99%

Mucormycosis - Dual Therapy with Prolonged Survival

Pecchio¹,

Osabio²,

Morales³

et al. 2019

RGH

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In 2014, a 69-year-old Panamanian female with a past medical history of diabetes mellitus type 2 and the presence of a pterygium on her conjunctiva had had resection a month prior of her pterygium and placement of an amniotic membrane graft to her left eye for which she had been treated with longterm corticosteroids. She presented to the emergency department of a hospital in Panama City, Panama with a history of one week of evolution of swelling of the right side of her face, ipsilateral eye proptosis and odynophagia. A large ulcer (3 X 4 cm) in her hard palate was evident. Her labs showed anemia (hematocrit 27%), leukocytosis (15,000 cells/mL 3), neutrophilia (73%), acute kidney injury (creatinine 2.0 mg/dL) and diabetic ketoacidosis with an elevated anion gap of 16 meq/L. As part of the emergency diagnostic approach, she had a nasal endoscopy during which they observed a necrotic lesion in the septum with cotton-like texture at the level of the nostrils. (Video 1) The CT scan revealed inflammatory changes, a fluid collection and inflammatory necrotic tissue in the masticatory space that extended on the right to the pterygopalatine fossa and orbital apex (Figure 1). There was involvement (anterior to posterior) of her right eye (proptosis), compromise of intra-and extraconal fat, the medial rectus muscle, and the superior orbital fissure, as well as asymmetry of the right cavernous sinus.

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“…There are 2 cases of successful treatment shown in Table 1. [9,10] A study of the 2 cases suggested that in operating on such a special infectious disease, complete elimination of the necrotic tissue and sufficient drainage should be the purpose of the operation. In addition, it may be helpful for the patient.…”

Section: Discussionmentioning

confidence: 99%

“…One patient underwent multiple debridement and drainage, and the other had a splenectomy, subtotal colectomy, terminal ileum resection, and multiple intraperitoneal irrigations. [9,10] The systemic antifungi therapy in both of these patients included amp B, micafungin, and posaconazole. The basic drug regimen is amp B, combined with micafungin, as soon as possible after the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient

Sun

Hou²,

Wang³

et al. 2017

Medicine

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Rationale:Gastrointestinal Mucormycosis (GIM) is a kind of opportunistic fungal infection with poor prognosis. It usually occurs in patients with immune deficiency. We reported a case of immunocompetent male patient.Patient concerns:This patient was presented as abdominal distension and gastrointestinal bleeding.Diagnoses:A variety of hemostatic methods was ineffective to stop the bleeding. The patient finally received laparotomy, and the jejunum lesions were found.Interventions:Pathological examination confirmed it to be gastrointestinal mucormycosis in jejunum.Outcomes:However, after systemic anti-fungi therapy, the patient died of septic shock.Lessons:The diagnosis mainly relies on pathological examination. Early diagnosis and early application of systemic amphotericin B liposome were fundamental for improving the prognosis.

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Survival of a Patient With Trauma-Induced Mucormycosis Using an Aggressive Surgical and Medical Approach

Cited by 20 publications

References 13 publications

Isolated Hepatic Mucormycosis in the Early Post-Transplant Period: A Case Report and Literature Review

Isolated Hepatic Mucormycosis in the Early Post-Transplant Period: A Case Report and Literature Review

Mucormycosis - Dual Therapy with Prolonged Survival

Gastrointestinal Mucormycosis of the Jejunum in an Immunocompetent Patient

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