Successful medical treatment of rhinocerebral mucormycosis complicating acute leukemia.

phadenopathy. Laboratory studies revealed a hematocrit of 18.3%, platelet count 118000/mm3, and leukocyte count of 5200/mm3 with 81% lymphoblasts, 1% myelocytes, 4% neutrophils and 14% lymphocytes. The bone marrow smear showed 95% blast cells. Intravenous piperacillin and gentamicin therapy was started on an empirical basis. After 10 days without response to the antibiotic regimen, he received a 7-day course of intensive chemotherapy with doxorubicin, enocitabine, etoposide, and prednisolone (referred to as HBEP), followed by treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF, Kirin Brewery Co., Ltd., Tokyo; 75 μg/day per body subcutaneously4)). Informed patient consent was obtained for the use of rhG-CSF. On the third day of antileukemic therapy, he complained of lacrimation in the right eye with slight lid edema, followed a few days later by pain and swelling in the right cheek and right upper medial area of the nose, and a seromucous nasal discharge from the right naris. Radiographic examination of the paranasal sinuses revealed opacification of the right maxillary, frontal, and ethmoid sinuses, without air-fluid levels. Computed tomography (CT) demonstrated soft-tissue densities in the right nasal cavity and right paranasal sinuses except for the sphenoid sinus (Fig. 1A). No bone destruction or intracranial involvement was seen. Examination of the nose revealed crusting over the right inferior turbinate with black discoloration. Biopsy of the lesion showed necrotic tissue with intensive invasion by non-septate hyphae of the Mucorales (Fig. 2). Cultures of the nose, however, were negative for fungi. Intravenous amphotericin B