A case of Acute Myelomonocytic Leukemia Diagnosed Before Death as Mucormycosis on the Basis of Pleural Fluid Culture.

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Remission induction therapy was conducted in a 62-year old female upon recurrence of acute myelomonocytic leukemia. However, symptoms of high fever, chest pain and dyspnea persisted, and chest x-rays showed infarction of the left lung, with shadows spreading all over this lung. Mucor sp. was detected in pleural fluid cultures. Although improvement was seen after i. v. injection of amphotericin B, the patient subsequently died due to aggravation of leukemia and onset of DIC and hepatic disorder. Although no necropsy could be conducted, chest x-rays and abdominal ultrasound revealed no recurrence of mucormycosis after the improvement achieved with amphotericin B. Mucormycosis is associated with fulminant and lethal symptoms and is very difficult to diagnose in a living being. In most cases it is diagnosed based on necropsy after the death of a patient. Few cases have been reported in which Mucor sp. was detectable in pleural fluid cultures and improvement could be achieved as in our case. Mycosis associated with hematological disease is one of the most important current medical problems. Prevention of infection, early diagnosis and alleviation of side effects associated with drugs used for its treatment are an important challenge for the future.
日本医真菌学会の論文