Mucormycosis: Association with Deferoxamine Therapy

M ucormycosis i an uncommon acute and often fatal opportunistic fungal infection that usually occurs in patients with poorly controlled iabetes mel-litus, acute leukemias, or other immunosuppressive conditions [1,2]. A new association, that of mucormy-cosis occurring in patients receiving deferoxamine therapy for iron or aluminum excess, has been report-ed with increasing frequency since 1986 [3-16]. Al-though this association has been strongly linked with chronic renal failure requiring hemodialysis, it is now clear that other conditions in which deferoxamine may be required (thalassemia, sideroblastic anemia, myelo-dysplasia) are also associated with mucormycosis [5,7,8,16]. We report a case of mucormycosis in a pa-tient who had received eferoxamine for iron overload secondary to myelodysplastic syndrome, and review previous cases of deferoxamine-associated mucormy-cosis. CASE REPORT A 56-year-old woman with myelodysplastic syn-drome for six years and transfusion-related iron over-load had received treatment with deferoxamine, 1 to 1.5 g per week, for seven months. She did well until June 1988, when she developed fever and a nonpro-ductive cough. She was admitted to another hospital where she was treated with tobramycin, ticarcillin-clavulanic acid, and erythromycin for presumed pneu-monia. Over the course of the first hospital day, she remained febrile to 40.0°C and became somnolent and disoriented. The next day she was transferred to th