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Case Reports
. 2022 Sep 16:12:960766.
doi: 10.3389/fcimb.2022.960766. eCollection 2022.

Nasal and cutaneous mucormycosis in two patients with lymphoma after chemotherapy and target therapy: Early detection by metagenomic next-generation sequencing

Qing Zhang  1 , Xingchen Liu  1 , Yanyan Liu  1 , Huiqin Wang  1 , Ran Zhao  1 , Xiaodong Lv  1 , Xudong Wei  1 , KeShu Zhou  1
Affiliations
Case Reports

Nasal and cutaneous mucormycosis in two patients with lymphoma after chemotherapy and target therapy: Early detection by metagenomic next-generation sequencing

Qing Zhang et al. Front Cell Infect Microbiol. .

Abstract

Mucormycosis is a conditionally pathogenic fungal disease with high morbidity that mainly affects patients with decreased immunity. Diagnosis relies on the histopathological examination of microorganisms with the typical structure of mucormycetes in tissues and subsequent confirmation via culture. Early detection of causative microorganisms is critical to rapidly administer appropriately targeted antibiotics. Metagenomic next-generation sequencing (mNGS) is an innovative and sensitive technique used to identify pathogenic strains. Here we used mNGS to timely diagnose an infection with Lichtheimia ramosa and Mucor irregularis in two patients with hematologic malignancies; the infections manifested as nasal and cutaneous infections and developed after chemotherapy and small molecule targeted therapy. Following treatment with amphotericin B cholesteryl sulfate complex, the symptoms were reduced significantly, and both patients obtained successful outcomes. Additionally, we searched and summarized the current medical literature on the successful diagnosis of mucormycosis using mNGS. These cases indicated that mNGS, a novel culture-independent method, is capable of rapid, sensitive, and accurate identification of pathogens. mNGS may be a complementary method for the early identification of mucormycosis, allowing for appropriate and timely antibiotic administration and thus improving patient outcomes.

Keywords: M. irregularis; cutaneous infection; lymphoma; metagenomic next-generation sequencing; mucormycosis; nasal infection. Lichtheimia ramosa.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Episode timeline of case 1. CRP, C-reactive protein; PCT, procalcitonin; ANC, absolute neutrophil count; MRP, meropenem; MIC, micafungin; CPS, cefoperazone sulfate; POS, posaconazole; LZD, linazolamide; TGC, tigecycline; PBS, polymyxin B sulfate; GCV, ganciclovir; AmBL, amphotericin B liposome; VCZ, voriconazole; MOX, moxalactam; CLM, clindamycin; ACV, acyclovir; ABCD, amphotericin B cholesterol sulfate complex.
Figure 2
Figure 2
Magnetic resonance imaging (MRI) and computed tomography (CT) images of the patient’s head (case 1). (A) MRI of the patient’s head on July 17: abnormal signal shadow of the ethmoid sinus, sphenoid sinus, and bilateral maxillary sinus. (B) CT scans of nasopharynx on July 24: soft tissue shadows are observed in the right nasopharynx, ethmoid sinus, nasal cavity, and maxillary sinus.
Figure 3
Figure 3
Episode timeline of case 2. CRP, C-reactive protein; PCT, procalcitonin; CCU, coronary heart disease care unit; LZD, linazolamide; PTZ, piperacillin sodium and tazobactam; MIC, micafungin; CPS, cefoperazone sulfate; VCZ, voriconazole; MRP, meropenem; AMK, amikacin sulfate; GCV, ganciclovir; ABCD, amphotericin B cholesterol sulfate complex.
Figure 4
Figure 4
Changes in cutaneous fungal infection (case 2). (A) Admitted. (B) November 1. (C) November 4. (D) Admitted. (E) November 4.
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