Case report/Cas clinique Voriconazole associated mucormycosis in a patient with relapsed acute lymphoblastic leukemia and hematopoietic stem cell transplant failure: A case report A. Sharifpour a , N. Gholinejad-Ghadi b , R. Ghasemian c , Z. Seifi b , S.R. Aghili d , E. Zaboli a , R. Abdi e , T. Shokohi d, * a Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran b Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran c Antimicrobial Resistance Research Center, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran d Department of Medical Mycology, School of Medicine/Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran e Department of Radiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 1. Introduction Mucormycosis is a fulminant infection, which almost always affects immunocompromised hosts. Oncology patients, solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients are at high risk for invasive fungal disease (IFD) mainly due to the severe and prolonged neutropenia related to high-dose chemotherapy and immunosuppressive drugs [1]. Due to increasing incidence of cancer, an increase in nosocomial mucormycosis is reported. Nosocomial mucormycosis has been linked with immunosuppressive drugs [2,3], prolonged use of intravenous catheter [4,5], antifungal prophylaxis [6,7], bandages [8] during the past two decades. Besides, there are some reports of mucormycosis after dental extraction associated with uncon- trolled diabetes [9]. Recently, an increase in incidence of mucormycosis has been reported linked to the voriconazole prophylaxis in many centers for control of invasive aspergillosis [10]. Here, we report mucormycosis associated voriconazole prophylaxis in a hematopoietic stem cell transplantation recipient for acute lymphoblastic leukemia and discuss the clinical manifestation, imaging, laboratory findings and therapeutic regimens. 2. Case report In May 2015, an 18-year-old man was admitted to Imam Khomeini Hospital in Sari with signs and symptoms of anemia, such as pallor, fatigue, dizziness and dyspnea. Investigations Journal de Mycologie Me ´ dicale xxx (2018) xxx–xxx * Corresponding author. Department of Medical Mycology /Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. E-mail addresses: asharifpour_0209@yahoo.com (A. Sharifpour), n.gholinejad.ghadi@gmail.com (N. Gholinejad-Ghadi), roya31gh@yahoo.com (R. Ghasemian), zhrseifi@gmail.com (Z. Seifi), aghili70@yahoo.com (S.R. Aghili), e.zaboli@mazums.ac.ir (E. Zaboli), sian_abdi@yahoo.com (R. Abdi), shokohi.tahereh@gmial.com (T. Shokohi). A R T I C L E I N F O Historique de l’article : Received 11 February 2018 Received in revised form 9 May 2018 Accepted 14 May 2018 Keywords: Mucormycosis Zygomycosis Invasive fungal disease Voriconazole Acute lymphoblastic leukemia Hematopoietic stem cell transplantation recipients Prophylaxis A B S T R A C T The patients with hematologic malignancies and hematopoietic stem cell transplantation (HSCT) recipients are at high risk for invasive fungal diseases (IFDs) mainly due to the severe and prolonged neutropenia related to high-dose chemotherapy. Voriconazole prophylaxis is recommended for possible IFDs. Mucormycosis is a fulminant infection, which may occur after voriconazole prophylaxis for invasive aspergillosis in immunocompromised hosts. Here, we report mucormycosis after 4 months of voriconazole prophylaxis in a young patient with relapsed acute lymphoblastic leukemia and hematopoietic stem cell transplant failure and discuss the clinical manifestation, imaging, laboratory findings and therapeutic regimens. Clinician’s awareness of this entity and timely diagnosis using conventional and molecular methods are the promising approach for the management of this devastating infection.  C 2018 Elsevier Masson SAS. All rights reserved. G Model MYCMED-809; No. of Pages 4 Please cite this article in press as: Sharifpour A, et al. Voriconazole associated mucormycosis in a patient with relapsed acute lymphoblastic leukemia and hematopoietic stem cell transplant failure: A case report. Journal De Mycologie Me ´ dicale (2018), https:// doi.org/10.1016/j.mycmed.2018.05.008 Available online at ScienceDirect www.sciencedirect.com https://doi.org/10.1016/j.mycmed.2018.05.008 1156-5233/  C 2018 Elsevier Masson SAS. All rights reserved.