SUCCESSFUL TREATMENT OF INVASIVE THORACOPULMONARY MUCORMYCOSIS IN A PATIENT WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

Background. Pulmonary mucormycosis associated with hematologic maligna ncy is an uncommon, but important opportunistic fungal pneumonia that is usually a fatal infection. Only a few survivors of pulmonary mucorm ycosis have been reported. Methods. A case report of invasive thoracop ulmonary mucormycosis during remission-induction therapy for acute lym phoblastic leukemia and a review of the literature are presented. Resu lts. The fungal lesions extended to both lungs, the left ribs, and int ercostal muscles. Percutaneous needle biopsy and immunostaining of the fungal hyphae established the diagnosis of thoracopulmonary mucormyco sis. The patient was treated with granulocyte-colony stimulating facto r (G-CSF) and intravenous amphotericin B for 9 weeks and the lesions i n the right lung disappeared. Left pneumonectomy and partial resection of the chest wall were later performed. The left lung was grossly nec rotic and contained a large cavity and bronchopulmonary fistula. There after, antileukemic therapy was resumed and completed without recurren ce of mucormycosis or leukemia. Conclusions. In the management of muco rmycosis, the addition of G-CSF to the conventional treatment may subs tantially improve outcome.