Mucormycosis in Leukemic Children

ABSTRACT

PURPOSE: Mucormycosis is an opportunistic fungal infection caused by one of the ubiquitous fungi of the order Mucorales, occurring almost exclusively in immunocompromised hosts such as patients with diabetes, leukemia and lymphoma. Recently the incidence of mucormycosis is rising associated with the increasing predisposing factors such as cytotoxic drugs and immunosuppressive agents. Though mucormycosis is frequently fatal, there has been a dramatic improvement in outcome by early diagnosis and aggressive treatment. The aim of this study is to investigate the clinical characteristics of mucormycosis developed in leukemic children. METHODS: Clinical characteristics of mucormycosis was analyzed by retrospective review of 6 patients diagnosed as mucormycosis during chemotherapy of acute leukemia at the Seoul National University Children's Hospital from May 1990 to May 1995. Diagnosis was confirmed by the pathologic examination of the biopsy specimens from the involved site. RESULTS: 1) The age distribution ranged from 7 to 15 years. Three patients were male and 3 were female. 2) At the onset of mucormycosis all six patients were under the cytotoxic chemotherapy with resultant neutropenia. Four of 6 patients received large doses of corticosteroids and 2 of 6 patients were receiving broad-spectrum antibiotics intravenously. 3) Of the 6 cases of mucormycosis, 5 cases were of the type involving a particular body site(rhinocerebral in 3 patients, gastrointestinal in 1 and laryngeal in 1) and 1 case was of the disseminated type. In a case of rhinocerebral type, the orbit as well as paranasal sinuses were involved and in the case of disseminated type, the lung, skin and muscle were invaded by the fungi. 4) Except one case(gastrointestinal type) in which complete resection of lesion was possible, amphotericin B was administrated for at least two months in combination with rifampin. Surgical resection was done in 4 cases. In a case who expired during medical treatment and the other one who was almost cured with medical treatment alone, surgery was not done. 5) Of the 6 cases, mucormycosis was cured in 3 cases and recurred in 1 case despite initial improvement. Two cases expired -one who showed almost complete improvement but expired due to bacterial sepsis during the following chemotherapy, and the other who showed little improvement with persistent neutropenia and expired due to septic shock. CONCLUSIONS: In the immunocompromised patients including acute leukemia, mucormycosis should be considered as a possible complicating condition, and early diagnosis and aggressive treatment may improve the survival and outcome.