T. Fukushima et al., SUCCESSFUL TREATMENT OF INVASIVE THORACOPULMONARY MUCORMYCOSIS IN A PATIENT WITH ACUTE LYMPHOBLASTIC-LEUKEMIA, Cancer, 76(5), 1995, pp. 895-899
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.