piperidines and Mucormycosis

Ibrutinib, a Bruton tyrosine kinase (BTK) inhibitor, has been approved for various hematological malignancies. Invasive aspergillosis is a known complication of ibrutinib, but mucormycosis is rare. We describe the case of a 70-year-old man with mantle cell lymphoma infiltrating the trachea, managed with a tracheobronchial stent and ibrutinib. He had improved one month after treatment, and we removed the airway stent. Four months later, he developed tracheal nodules confirmed to be tracheal mucormycosis and responded to liposomal amphotericin B (3.5 g) followed by posaconazole. After transient improvement, the tracheal lesions recurred, the biopsy showed lymphoma (with no evidence of mucormycosis), and he died. A systematic review of the literature identified 20 additional cases of ibrutinib-associated mucormycosis. Most of the 21 patients included were men (95%), and ibrutinib was the only risk factor in 15.7%. The reported mortality was 31.6% (6/19), attributable to mucormycosis in half the cases.

Topics: Adult; Aged; Female; Humans; Male; Mucormycosis; Neoplasm Recurrence, Local; Piperidines; Trachea

Acute invasive fungal infections of the head and neck secondary to tyrosine kinase inhibitors are rare and potentially life-threatening events.. We report a case of mucormycosis of the thyroid gland in a patient known for chronic lymphocytic leukemia receiving ibrutinib who presented with a rapidly growing thyroid nodule and dysphonia. An acute invasive fungal infection was identified on a core needle biopsy; mucormycosis was confirmed on culture. The patient was successfully treated with surgical debridement and long-term antifungal therapy.. Patients on ibrutinib may be at risk of acute invasive fungal infections of the head and neck.

Topics: Adenine; Agammaglobulinaemia Tyrosine Kinase; Aged; Cunninghamella; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Mucormycosis; Piperidines; Pyrazoles; Pyrimidines; Thyroid Nodule

Topics: Abdomen; Adenine; Aged; Fatal Outcome; Humans; Invasive Fungal Infections; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Mucorales; Mucormycosis; Multiple Organ Failure; Neoplasm Recurrence, Local; Opportunistic Infections; Piperidines; Pyrazoles; Pyrimidines; Thorax; Tomography, X-Ray Computed

Topics: Adenine; Adult; Aspergillosis; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Mucormycosis; Neoplasm Recurrence, Local; Nervous System; Piperidines; Pyrazoles; Pyrimidines