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  • Favourable outcome in a child with acute lymphoblastic leukaemia and pulmonary mucormycosis managed with combination antifungal therapy of liposomal amphotericin B and caspofungin

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Case report
Favourable outcome in a child with acute lymphoblastic leukaemia and pulmonary mucormycosis managed with combination antifungal therapy of liposomal amphotericin B and caspofungin
  1. Sanjeev Khera1,
  2. Vikram Singh2 and
  3. Somali Pattanayak3
  1. 1Department of Pediatrics, Army Hospital Research and Referral, New Delhi, Delhi, India
  2. 2Department of Pathology, Army Hospital Research & Referral, New Delhi, Delhi, India
  3. 3Department of Radiodiagnosis, Army Hospital Research and Referral, New Delhi, Delhi, India
  1. Correspondence to Dr Sanjeev Khera; kherakherakhera{at}gmail.com

Abstract

Pulmonary mucormycosis (PM) accounts for more than half the cases of mucormycosis in paediatric haematological malignancies, with mortality reaching as high as 90%. Surgical debridement of lesion along with liposomal amphotericin B (L-AMB) constitutes the mainstay of management of mucormycosis and offers best chances of survival. There are no reliable data available in the literature justifying the use of combination antifungal therapy (CAfT). We describe a child with acute lymphoblastic leukaemia (ALL) who developed multiple localised PM during induction chemotherapy. He was managed with CAfT with L-AMB and caspofungin in view of progressive PM on high-dose L-AMB monotherapy. There was complete resolution of PM after 6 months of CAfT at the end of intensive chemotherapy of ALL. There were no significant side effects of CAfT. CAfT may be of value in cases of mucormycosis refractory to high doses of L-AMB, where surgical debridement is not feasible.

  • haematology (drugs and medicines)
  • infections
  • pneumonia (infectious disease)
  • therapeutic indications

https://doi.org/10.1136/bcr-2021-245329

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    Footnotes

    • Contributors SK contributed to conceptualising of script and manuscript writing, diagnosis and management of case. VS and SP contributed to diagnosis and management.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.