A Rare Case of Disseminated Mucormycosis in an Immunocompromised Patient: Recovery Against All Odds

Introduction Mucormycosis is a deadly fungal infection, usually caused by the Mucorales family [1]. It is a rare condition with an estimated incidence of 1,7 per million per year [2]. Disseminated form is the most fatal manifestation of mucormycosis. It indicates the involvement of two or more organ systems and generally occurs in severely immunocompromised patients, including those with hematological malignancies [2]. Case Presentation A 37-year-old woman with newly diagnosed acute myeloid leukemia (AML) was treated with induction therapy. "7+3" regimen was started in January 2023. After 5 days of chemotherapy, she developed febrile neutropenia and paraplegia, with CT scans revealing abscesses in multiple organs - the brain, liver, lungs, and spleen. Despite broadspectrum antibiotics, her condition deteriorated. Bone marrow aspiration showed AML remission, but a suspected fungal infection led to treatment with liposomal amphotericin B. This caused life-threatening hypokalemia and vomiting, leading to ICU admission. Due to clinically and radiologically suspected mucormycosis, isavuconazole was added. A liver biopsy complicated by a haematoma confirmed mucormycosis in March, 2023. After stabilization, amphotericin B was stopped, and isavuconazole monotherapy continued. Despite severe infections and complications, her condition improved, AML remained in remission, and successful allogeneic hematopoietic stem cell transplantation (HSCT) was performed in September 2023. Discussion Diagnosing mucormycosis is challenging due to its rarity, nonspecific symptoms, rapid progression, and the need for tissue samples. In our case, early clinical suspicion, imaging, and recognition of risk factors, allowed immediate antifungal treatment, preventing extensive organ damage [3]. Given the 96% mortality rate of untreated disseminated mucormycosis, amphotericin B was continued despite adverse effects like hypokalemia [2]. Amphotericin B remains first-line therapy, while isavuconazole is a viable alternative for stable patients or those unable to tolerate amphotericin B [4]. Conclusions This case highlights the challenges in treating disseminated mucormycosis. The patient’s survival emphasizes the importance of early antifungal therapy, a multidisciplinary approach, and careful risk-benefit decision-making in immunocompromised patients.