Acute myeloid leukemia with sudden onset bilateral lower extremity paralysis caused by disseminated mucormycosis following unrelated bone marrow transplantation

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  • ITAKUSU Kyoko
    Division of Hematology, Ehime Prefectural Central Hospital
  • INOUE Tomonori
    Division of Hematology, Ehime Prefectural Central Hospital
  • ABE Masaya
    Division of Hematology, Ehime Prefectural Central Hospital
  • UEDA Ryo
    Division of Hematology, Ehime Prefectural Central Hospital
  • SAKURAI Aki
    Division of Hematology, Ehime Prefectural Central Hospital
  • MIYAZAKI Yukihiro
    Division of Hematology, Ehime Prefectural Central Hospital
  • NAKASE Koichi
    Division of Hematology, Ehime Prefectural Central Hospital
  • YOSHIDA Isao
    Department of Hemato-oncology, Shikoku Cancer Center
  • NAWA Yuichiro
    Division of Hematology, Ehime Prefectural Central Hospital

Bibliographic Information

Other Title
  • 非血縁者間同種骨髄移植後に播種性ムーコル症によって急激な両下肢麻痺を呈した急性骨髄性白血病
  • 症例報告 非血縁者間同種骨髄移植後に播種性ムーコル症によって急激な両下肢麻痺を呈した急性骨髄性白血病
  • ショウレイ ホウコク ヒケツエンシャ カン ドウシュ コツズイ イショク ゴ ニ ハシュセイ ムーコルショウ ニ ヨッテ キュウゲキ ナ リョウ カシ マヒ オ テイシタ キュウセイ コツズイセイ ハッケツビョウ

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Abstract

<p>A 63-year-old woman was admitted to our hospital with relapsed acute myeloid leukemia. On day10 after reinduction therapy, she became febrile. Computed tomography on day15 revealed right upper lobe consolidation. Because the β-D glucan and Aspergillus galactomannan antigen tests were negative, we considered pulmonary mucormycosis as a breakthrough infection under voriconazole administration. Liposomal amphotericin B was initiated, and the patient underwent unrelated bone marrow transplantation although not in complete remission. She developed right shoulder pain on day1, and her pneumonia worsened on day3. She reported right lower extremity paralysis on day15, and developed bilateral lower extremity motor and sensory paralysis the next day. T2-enhanced magnetic resonance imaging revealed hyperdense lesions in the spinal cord at Th11. Transverse myelitis was diagnosed, and she underwent antiviral therapy. After engraftment, she died of pneumonia on day24. Postmortem examination revealed disseminated mucormycosis involving the lungs, liver, diaphragm, blood vessels, and dura matter of the spinal cord; it also revealed that the sudden bilateral lower extremity paralysis was caused by disseminated mucormycosis. This case stresses the possibility of mucormycosis, particularly in prolonged neutropenic patients with pain, fever, and focal neurological findings.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 60 (1), 17-21, 2019

    The Japanese Society of Hematology

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