mercaptopurine and Mucormycosis

A 5-year-old patient treated for acute lymphoblastic leukaemia (ALL) developed proven pulmonary invasive fungal disease (IFD) due to Actinomucor elegans. While completing ALL treatment according to AIEOP ALL protocol 2009 for further 15 months, antifungal treatment with liposomal amphotericin B and intermittent additional posaconazole was continued until immune reconstitution 7 months after the end of ALL treatment. Repeated imaging guided treatment decisions. Twenty-six and 19 months after the end of ALL treatment and antifungal treatment, respectively, the patient is still in the first complete remission and shows no signs of active invasive fungal disease (IFD).

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child, Preschool; Cyclophosphamide; Cytarabine; Daunorubicin; Humans; Invasive Fungal Infections; Lung Diseases, Fungal; Male; Mercaptopurine; Methotrexate; Mucorales; Mucormycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Remission Induction; Triazoles; Vincristine

Topics: Adult; Antibodies, Monoclonal; Crohn Disease; Diagnosis, Differential; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Follow-Up Studies; Gastrointestinal Agents; Glucocorticoids; Humans; Immunosuppressive Agents; Infliximab; Laparotomy; Male; Mercaptopurine; Mucormycosis; Rhizopus; Rupture, Spontaneous; Stomach Rupture; Tomography, X-Ray Computed

A 28-year-old woman with acute lymphoblastic leukemia developed fever and unilateral pleural based pulmonary infiltrate during prolonged chemotherapy induced neutropenia. CT-guided lung biopsy confirmed the diagnosis of pulmonary mucormycosis and liposomal amphotericin B therapy was started. A few days after the initial symptoms, the patient developed convulsions and a brain abscess was detected in computerized tomography and magnetic resonance imaging. Fungal hyphae detected in histopathological examination of a brain biopsy had identical morphology with those seen in previous lung biopsies. The patient was treated with liposomal amphotericin B for five months and cytotoxic chemotherapy was successfully completed during antifungal therapy. Pulmonary infiltrates and the brain abscess resolved and the patient received an allogeneic bone marrow transplantation from a matched, unrelated donor. Antifungal therapy was continued for one additional month after bone marrow transplantation to prevent a relapse of invasive mucormycosis. Follow-up of the patient revealed no signs of relapse of invasive mucormycosis but two months after successful bone marrow transplantation the patient developed lethal cytomegalovirus pneumonitis which was confirmed by autopsy. No signs of mucormycosis were detected at post-mortem.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bone Marrow Transplantation; Brain Abscess; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Daunorubicin; Dexamethasone; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Liposomes; Lung Diseases, Fungal; Mercaptopurine; Mitoxantrone; Mucormycosis; Pneumonia, Viral; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Transplantation, Homologous; Vincristine

Mucormycosis is a rare fungal infection that has been described mainly in oncologic and diabetic patients. We here report the cases of two leukaemic patients in whom pulmonary mucormycosis was diagnosed. Prompt diagnosis, therapy with amphotericin B and surgery when possible, are the cornerstones in the treatment of this fungal infection. Although infrequent, this infection must be suspected in oncohaematological patients with lung infiltrates.

Topics: Adult; Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Fatal Outcome; Granulocyte Colony-Stimulating Factor; Humans; Immunologic Factors; Itraconazole; Leukemia, Promyelocytic, Acute; Lung Diseases, Fungal; Male; Mercaptopurine; Methotrexate; Mitoxantrone; Mucormycosis; Neutropenia; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acute Disease; Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Agranulocytosis; Aspergillosis; Candidiasis; Cytarabine; Female; Humans; Leukemia; Male; Mercaptopurine; Methotrexate; Middle Aged; Mucormycosis; Nocardia Infections; Prednisone; Proteus Infections; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Strongyloidiasis; Uracil; Vinblastine