A Case of Mucormycosis in a Patient with Myelodysplastic Syndrome and Review of the Literature in Korea

Kim, Jin Seok; Ko, Yun Woong; Jang, Joon Ho; Kim, Jong Yoon; Lee, Seung Tae; Min, Yoo Hong; Hahn, Jee Sook

Abstract

BACKGROUND: Mucormycosis is a highly virulent and rapidly progressive infectious disease caused by Mucorales. Immunocompromised hosts, such as patients with poorly controlled diabetes mellitus or diabetic ketoacidosis, patients receiving long-term deferoxamine therapy, and patients with hematologic malignancy, are predisposed to mucormycosis. We presented a case of brain abscess in a patient with myelodysplastic syndrome, and reviewed the cases of mucormycosis reported in Korea.
METHODS
Relevant reports on mucormycosis were collected by searching the Korean database of medical literature. A total of 57 cases from 41 reports in Korea were reviewed as to clinical types, predisposing factors, treatments, and outcomes.
RESULTS
The male to female ratio was 1.2:1. The mean age was 44 (range 1-72) years. The most frequent predisposing factor was diabetes mellitus (40 %), followed by the use of immunosuppressive agents (21%), and hematologic malignancies (16%). The most frequent clinical type was rhinocerebral (65%), followed by gastrointestinal (12%), pulmonary (9%), cutaneous (7%), and disseminated type (5%). The overall mortality rate was 33.3%, and the mortality rate in patients treated with surgical debridement was lower that in patients treated medically. The mortality rate in patients receiving surgical debridement only 13.3%, surgical debridement plus amphotericin B 26.9%, amphotericin B only 44.4%, and supportive care only 85.7%. Patients with disseminated type had a higher mortality rate than the other types.
Conclusions
Early diagnosis of mucormycosis followed by the removal of predisposing factors and aggressive management, such as early surgical debridement and use of amphotericin B greatly affect therapeutic outcome. Therefore, much attention to the clinical features and identification of the organism are warranted. Collaborative evaluation through the collection of more cases with mucormycosis may be required in order to clarify the characteristics of mucormycosis in Korea.