Appendiceal Perforation and Abdominal Wall Infection Caused by Invasive Mucormycosis in a Child with Acute Leukemia

Abstract

Gastrointestinal mucormycosis is one of the most difficult forms of the disease to diagnose due to its lack of specific clinical features. It is extremely rare to observe gastrointestinal mucormycosis in pediatric acute leukemia patients undergoing chemotherapy. In this report, we describe a case of a child with acute leukemia who developed invasive mucormycosis, leading to appendiceal perforation and abdominal wall infection. Initially, surgical intervention was delayed due to concerns over exacerbating bone marrow suppression, which ultimately resulted in the progression of the intra-abdominal infection. However, after thorough debridement of the abdominal wall infection and treatment with liposomal amphotericin B, the patient gradually recovered. This case highlights the importance of early and complete debridement of abdominal wall infections and intra-abdominal abscesses to prevent the further spread of mucormycosis, shorten the course of the disease, and improve outcomes.

Keywords: abdominal wall infection; acute leukemia; appendiceal perforation; children; invasive mucormycosis.

Figure 1

Clinical and histopathological progression of appendiceal perforation and abdominal wall infection caused by invasive mucormycosis in a child with acute leukemia. a. Histopathological appendix: Significant localized hemorrhage and necrosis of the appendix, with scattered infiltration of lymphocytes and neutrophils. Abundant hyphae present throughout the entire wall and within the blood vessels, PAS(+). b. Postoperative wound at the site of right abdominal puncture measuring approximately 4×1 cm, with blackened tissue and surrounding erythema measuring about 8×9 cm. c. Progression of right abdominal wall infection, characterized by the discharge of yellow-green feculent material, raising the suspicion of an enterocutaneous fistula. d. Worsening of the right abdominal wound infection with necrosis of the skin and subcutaneous tissue, exposing the ribs and penetrating the abdominal muscle layer, with visible liver tissue and fistula leakage. The arrow indicates the exposed rib. e. Postoperative image showing the colostomy bag following vacuum sealing drainage and enterostomy. f. Healing of the infection site, with granulation tissue formation visible.