1/78. Cryptic Mucor infection leading to massive cerebral infarction at initiation of antileukemic chemotherapy.A 74-year-old man with newly diagnosed acute myelogenous leukemia unexpectedly suffered a massive cerebral infarct on day 2 of induction chemotherapy. Clinically, the hemorrhagic infarct was thought to be due to leukostasis and thrombocytopenia. Necropsy, however, revealed that Zygomycetes-type hyphae had infiltrated cerebral vessels in and near the infarct. The fungal infection was clinically silent otherwise, although fungal elements were also identified in the lung at autopsy. This case illustrates how closely fungal infection may resemble a leukemia-associated cerebrovascular accident.- - - - - - - - - - ranking = 1keywords = leukemia (Clic here for more details about this article) |
2/78. Pulmonary mucormycosis caused by cunninghamella elegans in a patient with chronic myelogenous leukemia.cunninghamella elegans was cultured from autopsy materials of the infected lung of a patient with chronic myelogenous leukemia. The histologic sections revealed extensive growth of nonseptate, broad hyphae in and about the large and small arteries and veins, occluding the vessels. This case is believed to be the second in which human infection by C. elegans has been documented.- - - - - - - - - - ranking = 2.5keywords = leukemia (Clic here for more details about this article) |
3/78. basilar artery occlusion due to mucormycotic emboli, preceded by acute hydrocephalus.A rare case of brain stem infarction caused by mucormycotic emboli, preceded by acute hydrocephalus, is reported. The patient, who had suffered from leukemia and had undergone bone marrow transplantation several months before, presented initially with seizure and persistent disturbance of consciousness. A head CT scan revealed marked ventricular dilation and diagnosed as acute hydrocephalus. The patient received emergent ventricular drainage. Despite the aggressive treatment, the patient did not survive. autopsy revealed systemic mucormycosis occluding and invading various arteries including basilar artery and its branches, causing fatal brainstem infarction. Although early diagnosis remains difficult in the cases of systemic mucormycosis, prompt initiation of treatment is mandatory; one must have in mind the possibility of presence of fungal infection when treating patients with acute neurological deterioration who have underlying debilitating diseases, even though fungi themselves are hard to detect in most cases.- - - - - - - - - - ranking = 0.5keywords = leukemia (Clic here for more details about this article) |
4/78. Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia.mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin b and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin b therapy.- - - - - - - - - - ranking = 2.5keywords = leukemia (Clic here for more details about this article) |
5/78. Disseminated mucormycosis caused by absidia corymbifera leading to cerebral vasculitis.An 18-year-old woman was admitted to hospital because of subcutaneous hematoma and fever of unknown origin. Acute myeloid leukemia was diagnosed and empirical antimicrobial treatment and induction chemotherapy were started. After initial defervescence, fever relapsed 2 days after the onset of neutropenia. The CT scan of the lung was consistent with an invasive fungal infection. Treatment with amphotericin b was started and antimicrobial treatment was continued with liposomal amphotericin b because of an increase in creatinine later. The fever persisted and the patient suddenly developed progressive neurological symptoms. CT scan of the head suggested cerebral infarction and angiography of the extra- and intracranial arteries showed signs of vasculitis. Six days after the onset of neurological symptoms cerebral death was diagnosed. autopsy revealed non-septate, irregularly branched hyphae in various histologic sections including brain. absidia corymbifera could be isolated from lung tissue confirming the diagnosis of disseminated mucormycosis. In this case, angiographic findings suggested severe cerebral vasculitis which was in fact caused by thromboembolic dissemination of fungal hyphae. This case underlines the fact that cerebral symptoms in febrile neutropenic patients are highly indicative for fungal infections of the brain.- - - - - - - - - - ranking = 0.5keywords = leukemia (Clic here for more details about this article) |
6/78. mucormycosis resulting in a pseudoaneurysm in the spleen.mucormycosis is an uncommon and frequently fatal fungal infection. It characteristically affects patients with diabetes mellitus or patients with severe immunosuppression. The hallmark of mucormycosis infection is tissue infarction and vascular invasion. We present clinical data and imaging studies of a 16 year-old child with acute lymphoblastic leukemia complicated by disseminated mucormycosis resulting in a pseudoaneurysm of the spleen. This was successfully managed by a combination of systemic antifungal therapy (amphotericin b) and surgery (splenectomy). This entity has not been described in the literature.- - - - - - - - - - ranking = 0.5keywords = leukemia (Clic here for more details about this article) |
7/78. Rhinocerebral zygomycosis in a patient with acute lymphoblastic leukemia.We report a case of a 28-year-old man with acute lymphoblastic leukemia who developed rhinocerebral zygomycosis during induction chemotherapy. This life-threatening fungal infection is an infrequent cause of neutropenic fever, and is occasionally found in patients with leukemia and lymphoma, or patients with severely compromised defence mechanisms due to other diseases. It is caused by moulds belonging to the Mucoraceae family, and is characterized by local destruction of the affected organ. In our patient, the infection spread from the paranasal sinuses to the right orbit, destroyed intraorbital structures and resulted in blindness within days. biopsy from the right maxillary sinus was performed and mucormycosis was suspected through microscopic examination. culture of the resected specimen identified rhizopus arrhizus as the causing agent. Treatment of zygomycosis should consist of radical surgical debridement of the infected tissue, together with intensive broad-spectrum antimycotic therapy with amphotericin b. What could be learned from this case is, that aggressive approaches to identify the cause of infection is necessary, and that aggressive treatment strategies are inevitable to overcome the infection. Furthermore, treatment of the underlying disease should be continued as soon as possible.- - - - - - - - - - ranking = 3keywords = leukemia (Clic here for more details about this article) |
8/78. Liposomal amphotericin b and surgery in the successful treatment of invasive pulmonary mucormycosis in a patient with acute T-lymphoblastic leukemia.Pulmonary mucormycosis is a usually fatal opportunistic infection in immunocompromised patients. We describe the first case of an adult patient with hematological malignancy and profound neutropenia to survive a disseminated pulmonary rhizomucor pusillus infection. Early diagnostic procedures combined with high doses of liposomal amphotericin b and surgical resection may have contributed to the successful outcome.- - - - - - - - - - ranking = 2keywords = leukemia (Clic here for more details about this article) |
9/78. Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin b and incomplete surgery: a case report.BACKGROUND: mucormycosis (or zygomycosis) is the term for infection caused by fungi of the order mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. CASE PRESENTATION: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. mucormycosis was diagnosed based on these findings. amphotericin b (AmBisome(R); 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin b therapy was approximately 6 months and the total dose of liposomal amphotericin b used was 32 grams. Liposomal amphotericin b therapy was stopped six months later and oral fluconazole was started. CONCLUSIONS: Although a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone.- - - - - - - - - - ranking = 0.5keywords = leukemia (Clic here for more details about this article) |
10/78. Cure of pulmonary rhizomucor pusillus infection in a patient with hairy-cell leukemia: role of liposomal amphotericin b and GM-CSF.We describe a case of successfully treated multifocal pulmonary rhizomucor pusillus, a condition which has previously been universally fatal. A 77 year-old man had a background of chronic neutropenia due to hairy-cell leukemia, splenectomy, corticosteroid therapy and an obstructing left ureteric transitional-cell carcinoma. He was successfully treated with 3 months of high-dose liposomal amphotericin b and 7 months of granulocyte-macrophage colony-stimulating factor. Treatment was complicated by mild reversible deterioration of renal function. There was a near complete radiological response to the therapy at 6 months and the patient remains well 20 months following diagnosis of R. pusillus and 13 months following cessation of treatment.- - - - - - - - - - ranking = 2.5keywords = leukemia (Clic here for more details about this article) |
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