A'RARE'CASE'OF'SURVIVAL'IN'A'PEDIATRIC'PATIENT'WITH'PANISINUSITIS,'
SKULL'BASE'OSTEOMYELITIS'AND'CEREBRITIS'CAUSED'BY'RHIZOPUS'SPP'
POSTER'19'
'
Maria!Eduarda!Couto1,!Tereza!Oliva2,!Marta!Almeida2,!Vitor!Costa2,!Catarina!Sousa2,!Filipa!Almeida2,!
Silvia!Silva2,!Catia!Santos2,!Armando!Pinto2,!Pedro!Silva3,!Vitor!Leal3,!Tiago!Orfão3,!Ana!Lebre2!and!Ana!
Maia!Ferreira2!
!
(1)OncoUhematology!Service,!Instituto!Português!de!Oncologia!do!Porto,!F.G.,!E.P.E.,!Porto,!Portugal,!
(2)Instituto! Portugues! de! Oncologia! do! Porto,! E.P.E,! Porto,! Portugal,! (3)Hospital! São! João,! E.P.E.,!
Porto,!Portugal!
!
Background:'Infections!caused!by!Mucorales!have!a!bad!prognosis,!mainly!when!diagnosed!
in! immunosuppressed! patients.! Nowadays,! recommendations! for! the! treatment! of! these!
agents! include! early! diagnosis,! aggressive! surgical! treatment! and! endovenous! liposomal!
amphotericin! B! or! isavuconazol! as! first! and! second! line! antifungal! therapy.! There! are! few!
successful!cases!described!in!the!literature,!particularly!when!cerebritis!is!also!diagnosed.!
Aims:!Description! of! a! unique! clinical! case! report! of! a! severe! infection! in! a! patient! with! a!
lymphoma!in!remission.!
Methods:!The! authors! report! a! clinical! case! diagnosed! and! followed! in! one! oncological!
center.!
Results:!A! 14Jyear! old! boy,! with! acute! lymphoblast! lymphoma! in! remission! was! diagnosed!
with!Rhizopus!spp! pansinusitis,! skull! base! osteomyelitis! and! cerebritis! along! the!
maintenance! treatment.! The! first! signs! were! rhinorrhea! and! asthenia,! followed! by! a! facial!
paresthesia! and! ptosis! of! the! left! eye.! Imaging! was! suggestive! of! infection! by! Mucorales,!
later!confirmed.!Liposomal!amphotericin!B!and!posaconazol!were!promptly!prescribed!(the!
latter! being! replaced! later! by! isavuconazol,! due! to! its! low! grade! of! resistance! described!in!
the! literature! and! high! effectiveness! showed! against! Mucorales).The! patient! was! then!
diagnosed!with!cerebral!abscess,!requiring!neurosurgical!drainage,!perinasal!sinus!cleaning!
and!left!orbit!exenteration.!Hyperbaric!oxygen!therapy!chamber!was!also!used.!The!patient!
developed! multiple! true! mycotic! aneurysms! and! recurrent! left! orbital! encephalocele,!
corrected! after! orbital! reconstructive! surgery! and! duraplasty.! As! a! consequence! of! the!
neurosurgical! intervention,! the! patient! developed! left! frontal! lobe! herniation! through! the!
left! orbit! and! cerebral! spinal! fluid! fistula,! which! was! partly! corrected! using! an! appropriate!
glue,! after! two! unsuccessful! surgery! attempts.! After! 6Jmonths,! the! patient! became! stable!
(the! cerebritis! resolved),! able! to! do! his! daily! activities! autonomously.! He! did! intravenous!
antifungal! therapy! with! liposomal! amphotericin! B! (the! maximum! dose! achieved! was! 10!
mg/kg/daily,! being! later! progressively! lowered)! and! isavuconazol! for! 15! months;!
chemotherapy!was!reJstarted!4Jmonths!after!the!diagnosis!of!the!infection.!He!still!is!in!the!
maintenance!phase!of!the!oncologic!treatment,!under!oral!isavuconazol.!!
Conclusions:!This!is!a!rare!and!successful!case!of!an!aggressive!infection!management.!Early!
diagnosis,! fast! and! aggressive! surgery,! treatment! with! isavuconazol! and! liposomal!
amphotericin!B!and!a!multidisciplinary!team!were!determinants!for!the!success!achieved.!
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