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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(05): 491-495
DOI: 10.1055/s-0041-1739188
Case Report with Review of Literature

Palatal mucormycosis in neutropenic children: A Case Report with Review of Literature

K. Devaraja 
1   Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Neethu V. Krishnan
1   Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Vasudeva K. Bhat
2   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Kailesh Pujary
1   Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Archana M. Venkatagiri
2   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Kalasekhar Vijayasekharan    *
2   Division of Pediatric Hematology and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Abstract

Palatal involvement in mucormycosis is mostly secondary to rhino-orbito-cerebral disease, but rarely can be a primary disease of the oral mucosa. This report presents two rare cases of the isolated palatal mucormycosis in neutropenic children and highlights some of the peculiar features of the primary palatal disease and management-related issues in children. A 12-year-old child, who had completed the dexamethasone-based induction phase of chemotherapy for Near Early T cell precursor acute lymphoblastic leukemia, and a 9-year-old boy with a Late Isolated Medullary relapse of B cell acute lymphoblastic leukemia, who was to receive salvage induction chemotherapy, developed palatal discoloration without any other major complaints. Both had neutropenia and were on antifungal prophylaxis. In vitro staining of the discolored mucosa suggested mucormycosis, which was confirmed by pathological examination of the debrided tissue. Computed tomography, done before debridement, showed no significant sinonasal disease enabling us to proceed with the transoral approach. With the help of adjuvant antifungal therapy, the infection could be contained in both cases. This report, along with the reviewed literature, shows that limited palatal mucormycosis can be effectively treated by early diagnosis and debridement and appropriate antifungal therapy. Also, the role of antifungal prophylaxis amongst neutropenic patients has been briefly discussed here.

Keywords

febrile neutropenia - invasive fungal disease - palatal mucormycosis - mucormycosis - amphotericin-B - posaconazole

Authors' Contributions

The manuscript has been read and approved by all authors. All authors have contributed to this manuscript. Specifically, Dr. K Devaraja and Dr. Neethu V Krishnan were involved in all stages of the study including conceptualization, study design, the definition of intellectual content, literature review, clinical studies, data acquisition and analysis, and manuscript preparation, editing, and reviewing. Dr. Vasudev K. Bhat and Dr. Kalasekhar were involved in conceptualization, the definition of intellectual content, literature review, clinical studies, and manuscript preparation, editing, and reviewing. Dr. Kailesh Pujary and Dr. Archana M V were also involved in conceptualization, study design, literature review, clinical studies, and manuscript editing and reviewing.


Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms.


* Present address: Department of Pediatric Oncology, Regional Cancer Center, Trivandrum, Kerala, India




Publication History

Article published online:
11 December 2021

© 2021. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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