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Catastrophic Cerebral Infarctions in a Pediatric Patient with Acute Lymphoblastic Leukemia Due to Mucorales Infection

Summary

An 11-year-old girl with leukemia undergoing chemotherapy developed a severe fungal infection called mucormycosis caused by Lichtheimia ramosa. The infection spread rapidly from her sinuses to her eyes and brain, causing multiple blood clots in brain arteries and a massive stroke within just five days. Despite emergency surgery to remove the clots, the infection had progressed too far and the patient sadly did not survive, highlighting how dangerous this fungal infection can be in children with weakened immune systems.

Background

Mucormycosis is a rare but severe invasive fungal disease caused by molds from the order Mucorales, with particularly high mortality rates in immunocompromised pediatric patients with hematological malignancies. In children, hematological malignancies and hematopoietic cell transplantation are the leading underlying conditions, though the disease remains poorly characterized in the pediatric population.

Objective

This case report presents a fulminant and fatal case of rhino-orbito-cerebral mucormycosis in an 11-year-old girl undergoing re-induction chemotherapy for CNS relapse of acute lymphoblastic leukemia, addressing clinical presentation, diagnostic challenges, and the rapid progression of cerebral involvement.

Results

Pathological examination revealed extensive thrombotic occlusions in major cerebral arteries with fungal hyphae infiltrating arterial walls. NGS identified Lichtheimia ramosa, with nested PCR confirming genus Lichtheimia from blood specimens. The infection progressed from initial orbital and sinus involvement to catastrophic multiarterial thrombosis resulting in complete left hemisphere infarction within 5 days of symptom onset.

Conclusion

This case illustrates the rapidly progressive and fatal nature of Mucorales infection in immunocompromised children, emphasizing the critical importance of early clinical suspicion, comprehensive laboratory testing algorithms, and the need for better definition of risk factors and red flags to enable timely diagnosis and treatment initiation.
  • Published in:Journal of Fungi (Basel),
  • Study Type:Case Report,
  • Source: PMID: 41003164
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