Infect Chemother.  2012 Dec;44(6):516-521. 10.3947/ic.2012.44.6.516.

Hepatic and Small Bowel Mucormycosis after Chemotherapy in a Patient with Acute Myeloid Leukemia: A Case Report and Literature Review

• Yang TU
• Kim SH
• Choi BK
• Lee SW
• Park JH
• Hong KW
• Kim IS
• Seo YB
• Choi CW
• Kim WJ

• KMID: 1806946
• DOI: http://doi.org/10.3947/ic.2012.44.6.516

Abstract

We present a case of a 64-year-old woman with acute myeloid leukemia who developed a hepatic abscess during the neutropenic period after induction chemotherapy. To treat the abscess, meropenem and ciprofloxacin were administered to target Klebsiella pneumoniae and percutaneous drainage performed. As a result, the patient's fever and c-reactive protein (CRP) subsequently improved. After six weeks of antibiotic therapy, an abdominal computed tomography scan revealed remains of the liver abscess as well as an ileus in the small bowel. Molds from the Mucor genus were cultured from repeated liver abscess drainage and an abscess wall biopsy confirmed hepatic mucormycosis. Along with administration of amphotericin-B deoxycholate for four weeks, we performed lobectomy for hepatic mucormycosis and small bowel resection for a suspected small bowel mucormycosis. After these operations, the patient received liposomal amphotericin B for three weeks and was then maintained with oral posaconazole for more than four weeks. Our case report suggests that hepatic mucormycosis should be considered when a hepatic abscess exhibits a retarded response to antibacterial agents, especially for patients with risk factors. In addition, because an isolated hepatic mucormycosis is infrequent, a thorough search for the extent of the disease is necessary before surgical resection.

Keyword

Small bowel; Mucormycosis; Acute myeloid leukemia; Chemotherapy

MeSH Terms

Abscess
Amphotericin B
Anti-Bacterial Agents
Biopsy
C-Reactive Protein
Ciprofloxacin
Deoxycholic Acid
Drainage
Female
Fever
Fungi
Humans
Ileus
Induction Chemotherapy
Klebsiella pneumoniae
Leukemia, Myeloid, Acute
Liver Abscess
Mucor
Mucormycosis
Risk Factors
Thienamycins
Triazoles
Amphotericin B
Anti-Bacterial Agents
C-Reactive Protein
Ciprofloxacin
Deoxycholic Acid
Thienamycins
Triazoles

Figure

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  Figure 1 Abdominal CT scan shows A. ill defined abscess sized 1.5×1.5 cm in the left lateral segment of liver; B. circumferential edematous bowel wall thickening in the cecum.

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  Figure 2 Histopathologic findings in this case. (A) Few fragmented broad nonseptated, thin-walled fungal hyphae, morphologically suggestive of mucormycosis are noted in liver abscess wall biopsy (Hematoxylin and eosin stain, ×1,000). (B) A few hyphae from fungal organisms are in small bowel perforation site (Grocott-Gomori methenamine silver stain, ×400).

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