J Korean Med Sci.  2000 Jun;15(3):351-354. 10.3346/jkms.2000.15.3.351.

Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia

• Suh IW
• Park CS
• Lee MS
• Lee JH
• Chang MS
• Woo JH
• Lee IC
• Ryu JS

• KMID: 1128637
• DOI: http://doi.org/10.3346/jkms.2000.15.3.351

Abstract

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin B and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin B therapy.

Keyword

Mucormycosis; Liver; Intestine Small; Leukemia, Lymphocytic, Acute

MeSH Terms

Case Report
Female
Human
Intestinal Diseases/therapy
Intestinal Diseases/radiography
Intestinal Diseases/pathology*
Intestinal Diseases/microbiology
Intestine, Small/radiography
Intestine, Small/pathology
Liver Diseases/therapy
Liver Diseases/radiography
Liver Diseases/pathology*
Liver Diseases/microbiology
Middle Age
Mucormycosis/therapy
Mucormycosis/radiography
Mucormycosis/pathology*
Mucormycosis/microbiology
Tomography Scanners, X-Ray Computed