A clinical case of pulmonary form of mucormycosis in a child with acute lymphoblastic leukemia
https://doi.org/10.37748/2686-9039-2021-2-4-2
Abstract
Mucormycosis of the lungs is a severe infectious complication in patients with acute lymphoblastic leukemia, which develops at the stage of high-dose cytostatic therapy. It is characterized by an extremely aggressive, rapidly progressive course and, without specific treatment, is fatal in a short time. Reliable verification of mucor is necessary due to its resistance to the most commonly used antifungal drugs, particularly to voriconazole.
The article presents a clinical case of pulmonary mucormycosis in a 12‑year-old child at the stage of diagnosis of acute lymphoblastic leukemia. The first symptoms of the disease (headaches, malaise and weakness, pallor), changes in the general blood count (hyperleukocytosis up to 200 thousand cells/μl, single platelets). Based on the results of the examination, the main diagnosis was verified for acute lymphoblastic leukemia L2, IFT T-II, CD1a-. At the stage of diagnosis of acute lymphoblastic leukemia, the underlying disease was complicated by the development of right-sided pneumonia according to X-ray examination. To verify the etiology of infiltration of lung tissue, broncho-alveolar lavage was directed to microbiological diagnostics, which included studies: enzyme immunoassay, microscopic and cultural. On the aggregate of all the results obtained, invasive mucormycosis was diagnosed and antifungal therapy was started immediately.
About the Authors
Yu. Yu. KozelRussian Federation
Yuliya Yu. Kozel – Dr. Sci. (Med.), professor, head of the department of pediatric oncology
SPIN: 6923-7360
AuthorID: 732882
63 14 line str., Rostov-on-Don 344037
O. Yu. Kutsevalova
Russian Federation
Olga Yu. Kutsevalova – Cand. Sci. (Biol.), bacteriologist, head of the laboratory of clinical microbiology
SPIN: 6271-1942
AuthorID: 363005
Researcher ID: AAM-9837-2020
63 14 line str., Rostov-on-Don 344037
V. V. Dmitrieva
Russian Federation
Viktoriya V. Dmitrieva – Cand. Sci. (Med.), pediatric oncologist at the department of pediatric oncology
SPIN: 4416-7947
Author ID: 312405
63 14 line str., Rostov-on-Don 344037
O. V. Kozyuk
Russian Federation
Olga V. Kozyuk – pediatric oncologist at the department of pediatric oncology
SPIN: 1962-1920
Author ID: 734366
63 14 line str., Rostov-on-Don 344037
L. B. Kushtova
Russian Federation
Luiza B. Kushtova – graduate student
Rostov-on-Don
A. Kh. Khaspekyan
Russian Federation
Anaid Kh. Khaspekyan – hematologist at the department of pediatric oncology and hematology with chemotherapy
Rostov-on-Don
K. S. Aslanyan
Russian Federation
Karapet S. Aslanyan – Cand. Sci. (Med.), hematologist, head of the department of pediatric oncology and hematology with chemotherapy
Rostov-on-Don
References
1. Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Kong DCM, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2019 Jan;25(1):26–34. https://doi.org/10.1016/j.cmi.2018.07.011
2. Pana ZD, Seidel D, Skiada A, Groll AH, Petrikkos G, Cornely OA, et al. Invasive mucormycosis in children: an epidemiologic study in European and non-European countries based on two registries. BMC Infect Dis. 2016 Nov 10;16(1):667. https://doi.org/10.1186/s12879-016-2005-1
3. Nam BD, Kim TJ, Lee KS, Kim TS, Han J, Chung MJ. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur Radiol. 2018 Feb;28(2):788–795. https://doi.org/10.1007/s00330-017-5007-5
4. Lin E, Moua T, Limper AH. Pulmonary mucormycosis: clinical features and outcomes. Infection. 2017 Aug;45(4):443–448. https://doi.org/10.1007/s15010-017-0991-6
5. Hamilos G, Samonis G, Kontoyiannis DP. Pulmonary mucormycosis. Semin Respir Crit Care Med. 2011 Dec;32(6):693–702. https://doi.org/10.1055/s-0031-1295717
6. Reid G, Lynch JP, Fishbein MC, Clark NM. Mucormycosis. Semin Respir Crit Care Med. 2020 Feb;41(1):99–114. https://doi.org/10.1055/s-0039-3401992
7. Agrawal R, Yeldandi A, Savas H, Parekh ND, Lombardi PJ, Hart EM. Pulmonary Mucormycosis: Risk Factors, Radiologic Findings, and Pathologic Correlation. Radiographics. 2020 Jun;40(3):656–666. https://doi.org/10.1148/rg.2020190156
8. Feng J, Sun X. Characteristics of pulmonary mucormycosis and predictive risk factors for the outcome. Infection. 2018 Aug;46(4):503–512. https://doi.org/10.1007/s15010-018-1149-x
9. Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol. 2018 Apr 1;56(suppl_1):93–101. https://doi.org/10.1093/mmy/myx101
10. King J, Pana ZD, Lehrnbecher T, Steinbach WJ, Warris A. Recognition and Clinical Presentation of Invasive Fungal Disease in Neonates and Children. J Pediatric Infect Dis Soc. 2017 Sep 1;6(suppl_1):S12-S21. https://doi.org/10.1093/jpids/pix053
Supplementary files
Review
For citations:
Kozel Yu.Yu., Kutsevalova O.Yu., Dmitrieva V.V., Kozyuk O.V., Kushtova L.B., Khaspekyan A.Kh., Aslanyan K.S. A clinical case of pulmonary form of mucormycosis in a child with acute lymphoblastic leukemia. South Russian Journal of Cancer. 2021;2(4):13-17. https://doi.org/10.37748/2686-9039-2021-2-4-2