International Journal of Hematology

, Volume 93, Issue 3, pp 344–350

Rapid progression and unusual premortal diagnosis of mucormycosis in patients with hematologic malignancies: analysis of eight patients

  • Shingo Yano
  • Jiro Minami
  • Kaichi Nishiwaki
  • Takaki Shimada
  • Nobuaki Dobashi
  • Yuichi Yahagi
  • Yutaka Takei
  • Shinobu Takahara
  • Yoji Ogasawara
  • Katsuki Sugiyama
  • Yuko Yamaguchi
  • Takeshi Saito
  • Kinuyo Kasama
  • Hiroki Yokoyama
  • Tomohito Machishima
  • Atsushi Katsube
  • Noriko Usui
  • Keisuke Aiba
Original Article

DOI: 10.1007/s12185-011-0780-4

Cite this article as:
Yano, S., Minami, J., Nishiwaki, K. et al. Int J Hematol (2011) 93: 344. doi:10.1007/s12185-011-0780-4

Abstract

Mucormycosis is a rare but emerging group of life-threatening opportunistic mycoses. We described experience of eight patients who developed mucormycosis. These patients had developed hematologic malignancies, and none achieved complete remission. Six of the eight patients presented with neutropenia, five received corticosteroid, and four had concomitant hyperglycemia. The most frequent physical finding was fever, and five patients complained of facial pain, headache, or chest pain. Four patients presented with concomitant bacterial infection, pulmonary aspergillosis, or intestinal candidiasis. Premortal diagnosis of mucormycosis was made in only one patient. Postmortem biopsy or autopsy was the diagnostic tool for the other patients. Although patients who were treated with amphotericin B survived longer than those treated with micafungin or voriconazole, all patients died due to the progression of mucormycosis. Estimated median survival was 23 days. Premortal diagnosis was rarely achieved as biopsy of infected tissues was the only diagnostic tool, and four patients who revealed dual infection were diagnosed with aspergillosis or bacterial infections. In patients with a high risk of mucormycosis presenting with pain and uncontrollable fever, mucormycosis should be included in the differential diagnosis. High dosages of liposomal amphotericin B should be given and surgical debridement should be performed promptly in cases highly suggestive of mucormycosis.

Keywords

Mucormycosis Hematologic malignancies Liposomal amphotericin B Dual infection 

Copyright information

© The Japanese Society of Hematology 2011

Authors and Affiliations

  • Shingo Yano
    • 1
  • Jiro Minami
    • 1
  • Kaichi Nishiwaki
    • 1
  • Takaki Shimada
    • 1
  • Nobuaki Dobashi
    • 1
  • Yuichi Yahagi
    • 1
  • Yutaka Takei
    • 1
  • Shinobu Takahara
    • 1
  • Yoji Ogasawara
    • 1
  • Katsuki Sugiyama
    • 1
  • Yuko Yamaguchi
    • 1
  • Takeshi Saito
    • 1
  • Kinuyo Kasama
    • 1
  • Hiroki Yokoyama
    • 1
  • Tomohito Machishima
    • 1
  • Atsushi Katsube
    • 1
  • Noriko Usui
    • 1
  • Keisuke Aiba
    • 1
  1. 1.Division of Clinical Oncology and Hematology, Department of Internal MedicineJikei University School of MedicineTokyoJapan

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