Introduction
Hematological malignancies (HMs) are a group of malignant clonal
disorders that mainly affect the blood and hematopoietic tissues. They
are broadly categorized into myeloid and lymphoid lineages \RL
(1)\RL. Acute lymphoblastic leukemia (ALL) is classified as acute \RL
lymphoid lineage disorder. All hematological malignancies engage the
immune system and raise the chances of opportunistic infections mainly
invasive fungal infections \RL)IFIs\RL( (2).
Aspergillus and Mucorales species are emerged as
increasingly relevant and most common agents responsible for highly
lethal IFIs (3). The implementation of prophylaxis targetingCandida species in individuals with HMs has resulted in a higher
occurrence of Aspergillosis compared to Candida infections (4).
Aspergillus spp., the airborne microorganisms, can manifest in
three principal forms: invasive, saprophytic, and allergic (5). AlthoughAspergillus fumigatus (A. fumigatus ) is the predominant
species associated with disease, other species can also result in
invasive infections in profound immunocompromised patients (6).
Statistics indicate that invasive aspergillosis occurs in 4-15% of
cases and has a mortality rate between 60% and 85% (7). Mucormycosis,
a less frequent occurrence compared to aspergillosis, is a devastatingly
angioinvasive fungal infection caused by ubiquitous filamentous fungi
belonging to the Mucorales order (8). The main damage is
rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, and
disseminated, with a high mortality rate, estimated between 32% and
70% (9). Although lung is the most prevalent site of infection in
patients with hematologic malignancies, rhino-orbito-cerebral
mucormycosis (ROCM) is the most common form classically described in
diabetic patients (10).
Severe neutropenia (absolute neutrophil count below 500 cells/mm3) due
to toxic antineoplastic chemotherapies and myelosuppressive agents or
allogeneic hematopoietic stem cell transplantation (allo-HSCT) placing
HMs at a higher risk of evolving life-threatening infections with few
symptoms (11).
Herein we report a case of concomitant acute invasive fungal
rhinosinusitis (AIFR) and invasive pulmonary fungal infection withAspergillus and Mucoraceae species in a patient with pre B
cell ALL. This research was approved by the Ethics committee of Isfahan
University of medical sciences (IR.ARI.MUI.REC.1403.094), and written
informed consent was obtained from the patient.