Successful Isavuconazole Salvage Therapy for Cerebral Mucormycosis in A
child With Relapsed Leukemia, A light in The Dark Tunnel
Abstract
Mucormycosis is an angioinvasive lethal fungal infection in pediatric
cancer patients. We present 10-year-old female with relapsed B-cell
acute lymphoblastic leukemia undergoing chemotherapy was diagnosed with
isolated cerebral mucormycosis (ICM). Despite surgical debridement and
liposomal amphotericin B, repeat imaging showed concern for disease
progression. Chemotherapy was discontinued and the patient was
discharged on salvage therapy oral isavuconazole (ISAV). Over two months
later, the patient was unexpectedly clinically stable, and imaging
showed near resolution. After confirming continuous disease remission,
the patient was restarted on modified chemotherapy. Serial MRI’s during
continued chemotherapy showed stable MRI findings. This case illustrates
a rare presentation of successful salvage monotherapy ISAV for this
deadly infection with complete remission for relapsed leukemia.