Rhizopus Laryngitis Post Allogenic Stem Cell Transplantation

Mayank Dhamija,Sanjeev Kumar Sharma,Vipin Khandelwal,Dharma Choudhary,Gaurav Kharya,Divya Doval,Ramlingam Wvbs,Purabi Barman,Sweta Kothari

doi:10.3844/ajidsp.2016.46.49

Abstract

Invasive Fungal Infections (IFI) are an important complication and constitute significantly to mortality and morbidity, post Hematopoietic Stem Cell Transplant (HSCT). We report a very rare case of fungal laryngitis post HSCT in a 15-year-old girl with Thalassemia major. She received Busulphan, Cyclophosphamide and Antithymocyte Globulin (Bu-Cy-ATG) based conditioning pre Matched Sibling Donor (MSD) transplant and presented on day 10 post-transplant with hoarseness of voice progressing to stridor and respiratory obstruction. CT neck revealed laryngeal edema and she was ultimately diagnosed, by a laryngoscopy biopsy, histopathology and fungal culture to be having invasive fungal laryngitis due to Rhizopus. She responded partially to combination antifungal treatment with amphotericin B and posaconazole, family refused for laryngectomy and she was discharged with a tracheostomy tube in situ. Patient eventually succumbed due to bacterial sepsis. IFI should be considered in the differential diagnosis of unexplained symptoms post HSCT as timely intervention and treatment can save a lot of morbidity and mortality.

Highlights

Invasive fungal infections constitute one of the predominant infections in Hematopoietic Stem Cell Transplant (HSCT) recipients resulting in high morbidity and mortality
Invasive fungal infections constitute one of the predominant infections in HSCT recipients resulting in high morbidity and mortality
We present a case of fungal laryngeal chondritis caused by rhizopus in a patient with thalassemia major post allogenic HSCT, which is the first such case reported

Summary

Introduction

Invasive fungal infections constitute one of the predominant infections in HSCT recipients resulting in high morbidity and mortality. With the use of fluconazole prophylaxis, the incidence of candida infection has decreased significantly but the incidence of aspergillus and mucormycosis has increased (Marr et al, 2000; 2002). These infections are difficult to diagnose in the setting of cytopenias post stem cell transplant (Sharma et al, 2013). We present a case of fungal laryngeal chondritis caused by rhizopus in a patient with thalassemia major post allogenic HSCT, which is the first such case reported

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Funding Information