Overcoming the Odds: Successful Treatment of Disseminated Mucormycosis with Gastrointestinal and Jaw Involvement in a Patient with Acute Myeloid Leukemia.

Disseminated mucormycosis is a rare life-threatening fungal infection that is uniquely seen in severely immunocompromised patients including those with hematological malignancies. We report a case of disseminated mucormycosis with a biopsy-proven gastrointestinal and oral cavity involvement in a patient with acute myeloid leukemia during induction chemotherapy. The patient had a successful outcome with limited resection of the involvement bowel segment, multiple maxillary dental extractions, debridement of the alveolus and hard palate, and combined antifungal therapy. After clinical improvement, stable infection on serial abdominal imaging, and completion of 6 weeks of combined antifungal therapy, consolidation chemotherapy was given, and molecular remission was achieved. The patient remained clinically well on secondary antifungal prophylaxis.

One Disease, Multiple Hits: Acute Myeloid Leukemia With t(10;11) Presenting With Leukemic Lung Infiltration as First Presentation and Facial Nerve Palsy at Relapse.

Acute myeloid leukemia (AML) with t(10;11) is associated with poor outcomes. We report a rare case of monoblastic AML with mixed lineage leukemia (MLL) gene rearrangement t(10;11)(p11.2;q23) in a patient with extensive leukemic lung infiltration on his initial presentation leading to rapid deterioration following induction chemotherapy. Complete remission with negative cytogenetics was achieved following a limited induction due to acute respiratory failure. The patient subsequently relapsed with central nervous system involvement presenting with unliteral left lower motor neuron facial nerve palsy with cerebrospinal fluid positive for monoblasts.  Few unusual and challenging features were encountered with this patient including leukemic lung infiltration with extremely high lactate dehydrogenase (LDH) at the time of his initial presentation, rapid onset acute respiratory failure with no other identified causes within 48 hours of commencing induction chemotherapy. Additionally, achieving remission with only two days on induction chemotherapy and finally a stormy relapse with central nervous system involvement and left facial nerve palsy.

Pneumorrhachis with Spontaneous Pneumomediastinum: Should It Raise Special Concerns?

Spontaneous pneumomediastinum (SPM) is a rare and benign condition predominantly seen in young males. Patients present with non-specific pleuritic chest pain, cough, and dyspnea. Hence, it is difficult to diagnose in the acute setting until other serious differential diagnoses involving the integrity of the aerodigestive tract have been excluded. This results in over investigation and overtreatment until a diagnosis has been confirmed. We report a case of a 21-year-old Omani female who presented with a complaint of cough. She was diagnosed based on clinical and radiological findings after exclusion of hollow viscous perforation to have SPM extending to the spinal canal (pneumorrhachis). Her condition improved following conservative management, and she was sent home after three days.