Two cases of hepatic zygomycosis in allogeneic stem cell transplant recipients and review of literature

Infections in Leukemia and Hematopoietic Stem Cell Transplantation

Infections are one of the most common complications in patients diagnosed with leukemia and serve as a major obstacle to treatment. Through the early 1970s, infections were the most common cause of death in patients diagnosed with acute leukemia, but improvement in treatment and supportive care over the past few decades, coupled with expanded prophylaxis and prevention regimens, have led to reduction in both the frequency and severity of infections. Regardless, due in part to an aging cancer population and the diversity of cancer treatments and procedures, infectious diseases remain a major cause of morbidity and mortality in patients with leukemia.

Zygomycosis: an emerging fungal infection with new options for management

Zygomycosis occurs primarily in immunosuppressed patients and those with diabetes mellitus. Diabetes remains the most common risk factor; however, zygomycosis has increased among transplant recipients and patients with hematologic malignancy. Treatment or prophylaxis with voriconazole seems to be associated with the development of zygomycosis among severely immunosuppressed patients in these latter risk groups. Rhino-orbital-cerebral zygomycosis is the most common manifestation in patients with diabetes mellitus, but transplant recipients and patients with hematologic malignancy are more likely to develop pulmonary infection. Zygomycosis remains difficult to treat and requires a multifaceted approach involving elimination of predisposing factors, surgical debridement, and antifungal therapy. Lipid formulations of amphotericin B are the treatments of choice. The use of posaconazole has been successful in salvage trials but should not be used as first-line therapy until an effective intravenous formulation is available.