RESUMEN

Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient's condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes.

Asunto(s)

Coinfección , Fungemia , Mucormicosis , Leucemia-Linfoma Linfoblástico de Células Precursoras , Tricosporonosis , Humanos , Masculino , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Fungemia/microbiología , Fungemia/tratamiento farmacológico , Resultado Fatal , Coinfección/microbiología , Tricosporonosis/microbiología , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Lactante , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/complicaciones , Antifúngicos/uso terapéutico , Basidiomycota

RESUMEN

ABSTRACT Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient's condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes.

RESUMEN

Rhinocerebral and pulmonary mucormycosis are the main manifestations of mucormycosis; however, disseminated pulmonary associated with renal mucormycosis is rarely reported. In this paper, we report a rare fatal case of disseminated pulmonary and renal mucormycosis caused by Rhizopus microsporus in a 50-year-old man with poorly controlled hypertension, type 2 diabetes, and prolonged use of corticosteroids for the treatment of his reiterative gouty arthritis. In this patient, the use of corticosteroids and poorly controlled diabetes were considered underlying risk factor for his disseminated mucormycosis, along with acute renal dysfunction, suggesting the need for clinical suspicion of disseminated pulmonary and renal mucormycosis in hospitalized patients with poorly controlled diabetes and immunocompromised host.

Asunto(s)

Diabetes Mellitus Tipo 2 , Mucormicosis , Masculino , Humanos , Persona de Mediana Edad , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Rhizopus , Huésped Inmunocomprometido , Corticoesteroides

RESUMEN

ABSTRACT Rhinocerebral and pulmonary mucormycosis are the main manifestations of mucormycosis; however, disseminated pulmonary associated with renal mucormycosis is rarely reported. In this paper, we report a rare fatal case of disseminated pulmonary and renal mucormycosis caused by Rhizopus microsporus in a 50-year-old man with poorly controlled hypertension, type 2 diabetes, and prolonged use of corticosteroids for the treatment of his reiterative gouty arthritis. In this patient, the use of corticosteroids and poorly controlled diabetes were considered underlying risk factor for his disseminated mucormycosis, along with acute renal dysfunction, suggesting the need for clinical suspicion of disseminated pulmonary and renal mucormycosis in hospitalized patients with poorly controlled diabetes and immunocompromised host.