RESUMO
Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, we present the case of a 60-year-old Lebanese man with newly diagnosed acute myeloid leukaemia who developed oesophageal mucormycosis after induction chemotherapy with idarubicin/cytarabine (7+3). The diagnosis was made when the patient developed febrile neutropenia and odynophagia. CT scan of the chest revealed a thickened oesophagus. Oesophagogastroduodenoscopy with biopsy, histopathology and PCR were performed, resulting in the diagnosis of Rhizopus microsporus The patient was successfully treated with liposomal amphotericin B and salvage posaconazole therapy without surgical intervention. We reviewed the clinical characteristics of the six published oesophageal mucormycosis reports from the literature.
Assuntos
Doenças do Esôfago/imunologia , Hospedeiro Imunocomprometido , Quimioterapia de Indução/efeitos adversos , Mucormicose/imunologia , Rhizopus/imunologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Citarabina/efeitos adversos , Doenças do Esôfago/tratamento farmacológico , Doenças do Esôfago/parasitologia , Esôfago/imunologia , Esôfago/parasitologia , Humanos , Idarubicina/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/parasitologia , Triazóis/uso terapêuticoRESUMO
This case involved a 75-year-old woman with systemic lupus erythematosus. Two months previously, she had a flare that was treated successfully by increasing the dosages of prednisone and azathioprine. A sudden onset of ocular pain, diplopia, and loss of vision suggestive of optical neuritis or vascular involvement confused the issue, and rhinocerebral zygomycosis was demonstrated later. We review the presentations of this fungal infection in patients with systemic lupus erythematosus with emphasis on its initial features.
Assuntos
Infecções Fúngicas do Sistema Nervoso Central/etiologia , Lúpus Eritematoso Sistêmico/complicações , Mucormicose/etiologia , Idoso , Azatioprina/uso terapêutico , Infecções Fúngicas do Sistema Nervoso Central/patologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Mucormicose/parasitologia , Prednisona/uso terapêuticoRESUMO
Mucormycosis is historically associated with substantial morbidity and carries a very high mortality in renal transplant patients. The common sites of involvement include cerebral, pulmonary, gastrointestinal, or disseminated lesions. We report the successful outcome of gastric mucormycosis along with Strongyloides stercoralis infection in a renal transplant patient, who has survived for 5 years. We also review the literature.