Successful conservative treatment of severe mucormycosis in a pedriatic patient with acute leukemia

Invasive mucormycosis is a life-threatening fungal infection in patients with severe and prolonged immunoimmunodeficiency. Radical surgery with the aim to prevent local infiltration and septic dissemination is currently considered the Gold standard of therapy. However, especially in patients with ENT involvement, this approach often results in large defects with poor functional and cosmetic outcome, thus raising the question of alternative treatment options.

We here present the case of a 9-year-old girl with a form of acute myeloid leukemia who developed signs of severe mucormycosis of the lacrimal system with destruction of infraorbital structures and infiltration of the periorbital region following chemotherapy.

Following intense interdisciplinary discussion we opted for a course of systemic antimycotic therapy in addition to by careful wound management to avoid defacing radical surgery with enucleation of the right eye. During the course of several weeks we observed satisfactory secondary wound healing without impaired vision or diploic images and there were no signs of local or systemic mucor infection. After 8 weeks of conservative treatment we were able to resume polychemotherapy. During an observation periode if over 6 month the patient is in hematological remission and shows no signs of active mucor infection.

This case shows that even in patients with extensive mucormycosis and high risk for septic dissemination, conservative treatment may be feasable and result in superior functional and cosmetic outcome. A close cooperation of Pediatricians, Oncologists and ENT specialists is essential while caring for these challenging patients.

Publication History

Publication Date:
23 April 2019 (online)