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© 2019 Tashiro H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

CASE REPORT | OPEN ACCESSDOI: 10.23937/2469-5696/1410039

Fatal Systemic Mucormycosis after Rabbit Anti-Thymocyte Globulin Therapy in a Severe Aplastic Anemia Patient

Haruko Tashiro MD, PhD1*, Yasutoshi Oshima2, Ritsu Sumiyoshi1, Takuji Matsuo1, Tadashi Yamamoto1, Kensuke Matsumoto1, Jun Ooi1, Naohisa Matsunaga3, Yoshinao Kikuchi2 and Naoki Shirafuji1

1Department of Hematology/Oncology, Teikyo University School of Medicine, Japan

2Department of Pathology, Teikyo University School of Medicine, Japan

3Department of Infection Control and Prevention, Teikyo University Hospital, Japan


Survival rates for patients with severe aplastic anemia have greatly improved with the development of better supportive care including transfusion strategies and the availability of anti-fungal agents. However, invasive fungal infection remains the main cause of death and increases mortality in severe aplastic anemia patients. Among invasive fungal infections, mucormycosis is one of the fatal diseases in immunocompromised patients. We report the case of a 72-year-old man with severe aplastic anemia treated with immunosuppressive therapy consisting of rabbit anti-thymocyte globulin, cyclosporine, and steroids. The patient developed pneumonia, which did not respond to broad-spectrum antibiotics or echinocandin anti-fungal agents. The pneumonia rapidly progressed and the patient died of multi-organ failure on day 38 after the start of immunosuppressive therapy. The autopsy findings revealed that multiple organs, i.e., lungs, kidneys, heart, liver, spleen, thyroid, and pancreas, were invaded by fungi, and massive coagulative necrosis and thrombotic vessels were found in those organs. Our cultures of a tissue specimen from the patient's left lung were positive for Rhizomucor. We discuss the current problems related to severe aplastic anemia treatment in Japan.