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Abstract
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in patients with acute leukemia who are receiving chemotherapy. Primary prophylaxis with antifungal agents has become the standard of care in this setting; as a result, invasive candidiasis has shown a significant reduction. However, broad use of antifungal prophylaxis has led to an increase in breakthrough candidiasis with reduced susceptibility or resistance to fluconazole. In addition, an increase in breakthrough mucormycosis has been reported in studies of voriconazole prophylaxis. We report on a case of disseminated candidiasis and subsequent breakthrough pulmonary mucormycosis in a patient with acute myeloid leukemia undergoing consolidation chemotherapy. To the best of our knowledge, in Korea, this is the first report of these two independent IFIs occurring in a single patient.
Figures and Tables
Figure 1
(A) CT scan shows numerous micronodules in the liver; the spleen, in which similar tiny hypodense lesions had been seen, had been excised surgically. (B) Both pseudohyphae and the yeast form of Candida are observed in the microabscess. (Periodic Acid Schiff stain, ×1,000)
Figure 2
(A) CT scan shows a round consolidation in the left lower lobe of the lung, with a low attenuating necrotic area within. Still observed are numerous tiny nodules in the hepatic dome. (B) Microscopic view of the biopsy specimen shows numerous short folded hyphae with broad and right angle budding, which are characteristic of mucormycosis, within the abscess. (Hematoxylin & Eosin stain, ×1,000)
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