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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Dermatol. Aug 25, 2020; 8(1): 1-9
Published online Aug 25, 2020. doi: 10.5314/wjd.v8.i1.1
Rhinocerebral mucormycosis caused by Rhizopus oryzae in a patient with acute myeloid leukemia: A case report
Ya-Hui Feng, Wen-Wen Guo, Ya-Ru Wang, Wen-Xia Shi, Chen Liu, Dong-Mei Li, Ying Qiu, Dong-Mei Shi
Ya-Hui Feng, Wen-Xia Shi, Department of Clinical Medicine, Jining Medical University, Jining 272067, Shandong Province, China
Wen-Wen Guo, Department of Hematology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Ya-Ru Wang, Ying Qiu, Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Chen Liu, Laboratory of Clinical Mycology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Dong-Mei Li, Medical Center, Georgetown University, Washington, DC 20057, United States
Dong-Mei Shi, Laboratory of Medical Mycology, Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Author contributions: Shi DM and Qiu Y designed the case report; Feng YH, Shi DM, and Li DM analyzed all the data and wrote the manuscript; Guo WW, Wang YR, Shi WX, and Liu C collected the information; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81773337; Medical and Health Science Technology Project of Shandong Province, No. 2017WS345; and Traditional Chinese Medicine Science and Technology Development Plans of Shandong Province, No. 2017-415.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dong-Mei Shi, MD, PhD, Chief Doctor, Laboratory of Medical Mycology, Department of Dermatology, Jining No. 1 People’s Hospital, No. 6 Jiankang Road, Jining 272067, Shandong Province, China. shidongmei28@163.com
Received: January 29, 2020
Peer-review started: January 29, 2020
First decision: May 5, 2020
Revised: May 29, 2020
Accepted: June 20, 2020
Article in press: June 20, 2020
Published online: August 25, 2020
BACKGROUND
Rhinocerebral mucormycosis (RCM) is a rare fatal fungal infection which is on the increase among immunocompromised hosts such as patients who have had hematological cancers, or have received immunosuppressive drugs, corticosteroids, or other T cell suppressing agents.
CASE SUMMARY
We report a case of RCM caused by Rhizopus oryzae, one of the most common opportunistic pathogens, in a patient suffering from a fourth relapse of acute myeloid leukemia. The patient developed RCM after he had received long-term antibiotic agents and corticosteroids. The pathogen was isolated three times from nasal secretions collected from the deep parts of the nasal cavity and was identified by morphology and internal transcribed spacer sequencing. Blood infection was excluded by droplet digital polymerase chain reaction and blood culture. The patient was empirically treated with caspofungin and voriconazole for several days while the lesions continued to progress. The patient was given amphotericin B in combination with caspofungin after RCM was suspected, and the lesions improved over the course of treatment, which lasted several days. However, the patient eventually died of the primary disease.
CONCLUSION
This case indicates that immunosuppressive drugs, including corticosteroids and antimetabolites in hematological tumor, do increase the risk of infections of this type. Early diagnosis, prompt and frequent surgical debridement, and treatment with amphotericin B without delay are all essential in combatting RCM.
Core tip:Rhizopus oryzae, a common but also useful environmental fungus, is usually employed in the brewing industry. Cases of rhinocerebral mucormycosis in humans are relatively rare. The case we report confirmed the pathogenic fungi through repeated molecular identification and advanced droplet digital polymerase chain reaction technology. We also discuss the patient’s laboratory test results and the early inefficacy of azole antifungal drugs. The high-risk factors and effective treatment for Rhizopus oryzae in such patients are also discussed.
