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Liposomal amphotericin B and surgery as successful therapy for pulmonary Lichtheimia corymbifera zygomycosis in a pediatric patient with acute promyelocytic leukemia on antifungal prophylaxis with posaconazole

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Abstract

Pulmonary zygomycosis, also referred to as mucormycosis, is a fungal infection of lungs caused by fungi of the order Mucorales in the class of Zygomycetes. It is usually associated with high morbidity and mortality. Here, we report the case of a 14-year-old girl with pediatric acute promyelocytic leukemia (APL) on antifungal prophylaxis with posaconazole, who developed pulmonary Lichtheimia corymbifera (formerly Absidia corymbifera) zygomycosis. She was successfully treated by means of liposomal amphotericin B (L-AmB) and surgery. To our knowledge, this is the first published report on pediatric APL and pulmonary zygomycosis in the English language literature. At present, the patient is in complete remission of her APL and without any signs of recurrence of zygomycosis. This report suggests that efficient diagnostics, increased physician awareness, and reliance on adjunctive surgical therapy can result in a favorable outcome of pulmonary zygomycosis in immunocompromised children with hematological malignancies.

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References

  1. Pfaller MA, Diekema DJ. Epidemiology of invasive mycoses in North America. Crit Rev Microbiol. 2010;36:1–53.

    Article  PubMed  Google Scholar 

  2. Björkholm M, Runarsson G, Celsing F, Kalin M, Petrini B, Engervall P. Liposomal amphotericin B and surgery in the successful treatment of invasive pulmonary mucormycosis in a patient with acute T-lymphoblastic leukemia. Scand J Infect Dis. 2001;33:316–9.

    Article  PubMed  Google Scholar 

  3. Antoniadou A. Outbreaks of zygomycosis in hospitals. Clin Microbiol Infect. 2009;15(Suppl 5):55–9.

    Article  PubMed  Google Scholar 

  4. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53.

    Article  PubMed  Google Scholar 

  5. Anderson ML. Infectious causes of bovine abortion during mid- to late-gestation. Theriogenology. 2007;68:474–86.

    Article  PubMed  Google Scholar 

  6. Piancastelli C, Ghidini F, Donofrio G, et al. Isolation and characterization of a strain of Lichtheimia corymbifera (ex Absidia corymbifera) from a case of bovine abortion. Reprod Biol Endocrinol. 2009;7:138.

    Article  PubMed  Google Scholar 

  7. Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E. Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma. 2004;45:1351–60.

    Article  PubMed  CAS  Google Scholar 

  8. Liu ZH, Lv GX, Chen J, et al. Primary cutaneous zygomycosis due to Absidia corymbifera in a patient with cutaneous T cell lymphoma. Med Mycol. 2009;47:663–8.

    Article  PubMed  CAS  Google Scholar 

  9. Horré R, Jovanic B, Herff S, et al. Wound infection due to Absidia corymbifera and Candida albicans with fatal outcome. Med Mycol. 2004;42:373–8.

    Article  PubMed  Google Scholar 

  10. Mohammed S, Sahoo TP, Jayshree RS, et al. Sino-oral zygomycosis due to Absidia corymbifera in a patient with acute leukemia. Med Mycol. 2004;42:475–8.

    Article  PubMed  Google Scholar 

  11. Hopwood V, Hicks DA, Thomas S, Evans EGV. Primary cutaneous zygomycosis due to Absidia corymbifera in a patient with AIDS. J Med Vet Mycol. 1992;30:399–402.

    Article  PubMed  CAS  Google Scholar 

  12. Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007;45:321–46.

    Article  PubMed  Google Scholar 

  13. Torres-Narbona M, Guinea J, Martinez-Alarcon J, et al. Impact of zygomycosis on microbiology workload: a survey study in Spain. J Clin Microbiol. 2007;45:2051–3.

    Article  PubMed  Google Scholar 

  14. Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992–1993: results of population-based laboratory active surveillance. Clin Infect Dis. 1998;27:1138–47.

    Article  PubMed  CAS  Google Scholar 

  15. Skiada A, Pagano L, Groll A, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European confederation of medical mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011;17:1859–67.

    Article  PubMed  CAS  Google Scholar 

  16. Lanternier F, Dannaoui E, Morizot G, et al. A global analysis of mucormycosis in France: the retrozygo study (2005–2007). Clin Infect Dis. 2012;54(Suppl 1):S35–43.

    Article  PubMed  CAS  Google Scholar 

  17. Zaoutis TE, Roilides E, Chiou CC, et al. Zygomycosis in children: a systematic review and analysis of reported cases. Pediatr Infect Dis. 2007;26:723–7.

    Article  Google Scholar 

  18. Dehority W, Willert J, Pong A. Zygomycetes infections in pediatric hematology oncology patients: a case series and review of the literature. J Pediatr Hematol Oncol. 2009;31:911–9.

    Article  PubMed  Google Scholar 

  19. Giacchino M, Milano GM, Carraro F, et al. Current evidence of antifungal prophylaxis and therapy in pediatric patients. Pediatr Rep. 2011;3:e6.

    Article  PubMed  Google Scholar 

  20. O’Brien D, Lim CH, Farrell M, et al. Invasive intracerebral fungal infection in a leukaemic patient. Br J Neurosurg. 2012;26:423–5.

    Article  PubMed  Google Scholar 

  21. Mantadakis E, Samonis G, Kalmanti M. A comprehensive review of acute promyelocytic leukemia in children. Acta Haematol. 2008;119:73–82.

    Article  PubMed  Google Scholar 

  22. Bally C, Fadlallah J, Leverger G, et al. Outcome of acute promyelocytic leukemia (APL) in children and adolescents: an analysis in two consecutive trials of the European APL group. J Clin Oncol. 2012;30:1641–6.

    Article  PubMed  CAS  Google Scholar 

  23. Marty FM, Cosimi LA, Baden LR. Breakthrough zygomycosis after voriconazole treatment in recipients of hematopoietic stem-cell transplants. N Engl J Med. 2004;350:950–2.

    Article  PubMed  CAS  Google Scholar 

  24. Trifilio SM, Bennett CL, Yarnold PR, et al. Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy. Bone Marrow Transplant. 2007;39:425–9.

    Article  PubMed  CAS  Google Scholar 

  25. Schalk E, Mohren M, Jentsch-Ullrich K, et al. Zygomycoses in patients with acute leukaemia. Ann Hematol. 2006;85:327–32.

    Article  PubMed  Google Scholar 

  26. Herbrecht R. Posaconazole: a potent, extended-spectrum triazole anti-fungal for the treatment of serious fungal infections. Int J Clin Pract. 2004;58:612–24.

    Article  PubMed  CAS  Google Scholar 

  27. Sun QN, Najvar LK, Bocanegra R, Loebenberg D, Graybill JR. In vivo activity of posaconazole against Mucor spp. in an immunosuppressed-mouse model. Antimicrob Agents Chemother. 2002;46:2310–2.

    Article  PubMed  CAS  Google Scholar 

  28. Greenberg RN, Mullane K, van Burik JA, et al. Posaconazole as salvage therapy for zygomycosis. Antimicrob Agents Chemother. 2006;50:126–33.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We acknowledge Dr. J. Hubert for linguistic expertise.

Conflict of interest

The authors report no conflict of interest.

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Authors and Affiliations

  1. Centre of Hematology and Oncology, Children’s Hospital, Vilnius University Hospital Santariskiu Clinics, Santariskiu street 4, LT-08406, Vilnius, Lithuania

    Grazina Kleinotiene, Sigita Stankeviciene & Valentina Daugelaviciene

  2. Clinic of Pediatric Surgery, Children’s Hospital, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania

    Gintas Posiunas

  3. Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Juozas Raistenskis

  4. Children’s Hospital, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania

    Juozas Raistenskis

  5. Lithuanian National Centre of Pathology, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania

    Edvardas Zurauskas

  6. Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Edvardas Zurauskas

  7. Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, and Hematology Center Karolinska, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden

    Maciej Machaczka

Authors
  1. Grazina Kleinotiene
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  2. Gintas Posiunas
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  3. Juozas Raistenskis
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  4. Edvardas Zurauskas
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  5. Sigita Stankeviciene
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  6. Valentina Daugelaviciene
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  7. Maciej Machaczka
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Correspondence to Grazina Kleinotiene or Maciej Machaczka.

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Kleinotiene, G., Posiunas, G., Raistenskis, J. et al. Liposomal amphotericin B and surgery as successful therapy for pulmonary Lichtheimia corymbifera zygomycosis in a pediatric patient with acute promyelocytic leukemia on antifungal prophylaxis with posaconazole. Med Oncol 30, 433 (2013). https://doi.org/10.1007/s12032-012-0433-3

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  • DOI: https://doi.org/10.1007/s12032-012-0433-3

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