Fungal sinusitis due to mucormycosis in a diabetic immunosuppressed patient with acute myeloid leukemia (AML)

Abstract

Introduction: Mucormycosis is an acute onset, invasive, fungal infection, characterized by organ involvement, and caused by Mucor, Rhizopus, or Absidia. Our aim was to present a case of mucormycotic infection and emphasize its importance in a diabetic immunosuppressed patient with acute myeloid leukemia (AML).

Case presentation: A 68-year-old hypertensive and diabetic male patient with a diagnosis of AML developed respiratory failure and exhibited diffuse bilateral consolidation in high-resolution computed tomography (HRCT). The treatment plan involved chemotherapy with cytarabine (200 mg/m²/day for 7 days) and daunorubicin (60 mg/m²/day for 3 days) starting on 20 July 2022. Posaconazole prophylactic treatment was initiated on 23 July 2022, to prevent fungal infections. Five days later there was a black necrotic appearance on the left wing of the nose. The patient underwent excision of the left wing of the nose. Mucor was detected in the excision tissue both histopathologically and in culture. A culture under lactophenol cotton blue (LFCB) staining displaying hyphal structures of Mucor was obtained. The patient died of progressive pneumonia and sepsis.

Conclusions: Mucormycosis is an infection with high mortality, and should be considered in the early stages of diagnosis when dealing with immunosuppression patients.