Favourable outcome in a child with acute lymphoblastic leukaemia and pulmonary mucormycosis managed with combination antifungal therapy of liposomal amphotericin B and caspofungin.
Sanjeev KheraVikram SinghSomali PattanayakPublished in: BMJ case reports (2021)
Pulmonary mucormycosis (PM) accounts for more than half the cases of mucormycosis in paediatric haematological malignancies, with mortality reaching as high as 90%. Surgical debridement of lesion along with liposomal amphotericin B (L-AMB) constitutes the mainstay of management of mucormycosis and offers best chances of survival. There are no reliable data available in the literature justifying the use of combination antifungal therapy (CAfT). We describe a child with acute lymphoblastic leukaemia (ALL) who developed multiple localised PM during induction chemotherapy. He was managed with CAfT with L-AMB and caspofungin in view of progressive PM on high-dose L-AMB monotherapy. There was complete resolution of PM after 6 months of CAfT at the end of intensive chemotherapy of ALL. There were no significant side effects of CAfT. CAfT may be of value in cases of mucormycosis refractory to high doses of L-AMB, where surgical debridement is not feasible.
Keyphrases
- particulate matter
- air pollution
- polycyclic aromatic hydrocarbons
- liver failure
- high dose
- heavy metals
- pulmonary hypertension
- water soluble
- mental health
- candida albicans
- respiratory failure
- systematic review
- intensive care unit
- multiple sclerosis
- emergency department
- aortic dissection
- low dose
- big data
- hepatitis b virus
- risk assessment
- machine learning
- cardiovascular events
- open label
- single molecule
- cardiovascular disease
- stem cell transplantation
- artificial intelligence
- data analysis
- coronary artery disease
- extracorporeal membrane oxygenation
- mechanical ventilation