Invasive mucormycosis during treatment for acute lymphoblastic leukaemia\u2014successful management of two life-threatening diseases

Andreas Trobisch,S Flaschberger,M Seidel,B Kohlmaier,M Egger,H Lackner,V Strenger,C Urban,M Benesch,A Karastaneva,D Sperl,G Gorkiewicz,R Marterer

doi:10.1007/s00520-019-04962-3

Andreas Trobisch, S Flaschberger + Show 11 more

Open Access

https://doi.org/10.1007/s00520-019-04962-3

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Abstract

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).

Highlights

Invasive mould diseases remain an important cause of death in immunocompromised patients [1, 2]
Differentiation between mucormycoses and other mould infections remains challenging, since these pathogens are difficult to culture and show similar radiological and clinical features leading from 4% to up to 90% of suspected mucormycosis cases not being confirmed until post-mortem examination [1, 4, 5]
We describe the successful management of mucormycosis during acute lymphoblastic leukaemia (ALL) treatment

Summary

Introduction

Invasive mould diseases remain an important cause of death in immunocompromised patients [1, 2]. A 5-year-old patient was treated for precursor B cell acute lymphoblastic leukaemia (ALL) according to AIEOP BFM ALL 2009 protocol for 7 months in the non-high-risk arm. For digestive decolonisation, he continuously received oral amphotericin B. Four months after the start of antifungal treatment, we performed a PET-CT scan still showing multifocal metabolically active consolidations in both lungs. After 12 months of antifungal therapy with slight radiologic improvement, CT scan again showed an increase of infiltrates, leading to an increase in AmBisome® dosages to 5 mg/kg/day every 3rd day and reinitiation of posaconazole at an increased dosage of 20 mg/kg/day.

Discussion

Findings

Compliance with ethical standards