INVASIVE MUCORMYCOSIS IN PATIENTS WITH APLASTIC ANEMIA: REPORT OF TWO FATAL CASES
TL;DR
Two cases of mucormycosis occurring in patients with idiopathic aplastic anemia highlight the particular difficulty of treating mucormycosis in patients with aplastic anemia, in whom the aggressiveness of the infection is compounded by hematological constraints that limit surgery and wound healing.
Abstract
Mucormycosis is a rare, angioinvasive, rapidly progressive invasive fungal infection that occurs preferentially in patients with profound immunosuppression. Hematological disorders, particularly prolonged neutropenia, are major risk factors. Management relies on early diagnosis,antifungal therapy active against Mucorales, surgical debridement when feasible, and correction of predisposing factors. We report two cases of mucormycosis occurring in patients with idiopathic aplastic anemia. The first, a 14-year-old patient, presented with facial and mandibular involvement occurring after dental extraction. Biopsy demonstrated mycelial filaments. Despite liposomal amphotericin B, hematological optimization, and surgical debridement with mandibular curettage, the course was complicated by hemorrhage, delayed healing, progressive necrosis, and fatal septic shock on postoperative day 5. The second patient, aged 40 years, presented with a necrotic palatal lesion associated with maxillary and sinus involvement. Histology confirmed mucormycosis. Fever, cough, and pulmonary foci subsequently developed, raising suspicion of disseminated disease, followed by death in the setting of acute respiratory distress. These cases highlight the particular difficulty of treating mucormycosis in patients with aplastic anemia, in whom the aggressiveness of the infection is compounded by hematological constraints that limit surgery and wound healing. Early clinical suspicion and close coordination among hematologists, infectious disease specialists, surgeons, and intensivists are essential.