Conclusion and Results
Based on these results the diagnosis of concomitant probable invasiveAspergillus rhinosinusitis and confirmed invasive Mucor rhinosinusitis with concomitant probable invasive pulmonary
aspergillosis (IPA) and probable pulmonary mucormycosis was made. After
7 days of therapy the patient underwent sinuses endoscopy for second
look and no evidence of necrosis was reported. Meropenem, ciprofloxacin,
and vancomycin were stopped and treatment based on liposomal
amphotericin B was continued\RL. He was afebrile on day 5 of
treatment.
Repeated lung HRCT showed a slight reduction in the size and number of
the nodular lesions after 22 days of antifungal therapy. According to
the patient’s need to start consolidation chemotherapy, high dose
methotrexate with leucovorin and ara-C regimen was started after 22 days
from the start of liposomal amphotericin B.
The patient underwent 4 ENT consults and no evidence of necrosis was
reported in endoscopies. The lung HRCT revealed significant improvement
and after 37 days the liposomal amphotericin B was overlapped with
posaconazole suspension 200 mg every 6 hr for 5 days and then liposomal
amphotericin B was discontinued. The posaconazole suspension was
continued with this therapeutic dose for 30 days. At the time of writing
this paper, 5 months follow-up demonstrated no evidence of infection
recurrence and the courses of chemotherapies are continued under
posaconazole secondary prophylaxis. The timeline of the patient
treatment was showed in [Figure 7] .
This case report highlights the implication of considering the
sinopulmonary Aspergilosis and mucor mycosis coinfection in
a patient with acute leukemia as there are not so many cases described
in the literature.
The keys to optimize the management of these coinfectional situations
include a high index of suspicion for the disease with early detection
of the signs and symptoms by a multidisciplinary approach, rational
antifungal therapy and if necessary, aggressive surgical resection.
As there is no evident consensus concerning the therapy in mixed
fungal-infections, more potent and focused line of treatment as compared
to infection with a single fungal agent will be required.