Very severe aplastic anemia in a child with pulmonary mucormycosis: a case report

Abstract

Aplastic anemia (AA), is a rare but potentially life-threatening disease characterized by pancytopenia and a hypocellular bone marrow. Pulmonary mucormycosis (PM) is a rare but life-threatening fungal infection observed in immunocompromised patients, particularly those with neutropenia and those using corticosteroids, with a high mortality rate from 40 to 80%. However, PM diagnosis and treatment remain challenging. This study reports a case of very severe aplastic anemia (VSAA) in a male child with PM. The innovation of this article lies in the following aspects: the patient exhibited typical clinical manifestations, the reverse halo sign (RHS) on chest computed tomography (CT), and a positive metagenomic next-generation sequencing (mNGS) analysis; despite aggressive anti-infective treatment and left lower lobectomy, he experienced a poor clinical outcome. Reflecting on cases with poor prognosis can indeed offer valuable insights and opportunities for learning. This study underlines the diagnostic challenges in mucormycosis, which should be considered in persistent fever that is unresponsive to standard antibiotic and antifungal therapies, and conduct a comprehensive examination to achieve early detection, diagnosis and treatment. It was concluded that, in addition to antifungal treatment, early surgery is essential for treating mucormycosis.

Keywords: left lower lobectomy; metagenomic next-generation sequencing; pulmonary mucormycosis; reverse halo sign; very severe aplastic anemia.

Figure 1

(A) Plain CT scan image of the left lung on day 2. (B) An emergency CT scan image obtained after 12 days indicates patchy ground-glass shadows in the dorsal segment of the left lower lobe. (C) An enhanced CT image obtained after 22 days shows a reverse halo sign in the left lung. (D) Enhanced CT image obtained on day 30 presents the left lung infarction. (E) Surgical photos of lesions showing the left lower lobe infarction.

Figure 2

(A) Core body temperature curves. (B) The treatment timeline. VSAA, very severe aplastic anemia; CT, computed tomography; VP – 16, etoposide; mNGS, metagenomic next-generation sequencing.