AUTHOR=Shen Meixiao , Li Qian , Zeng Zhaocheng , Han Dongxu , Luo Xiansheng 

TITLE=Mucor indicus caused disseminated infection diagnosed by metagenomic next-generation sequencing in an acute myeloid leukemia patient: A case report

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1089196

DOI=10.3389/fcimb.2023.1089196

ISSN=2235-2988

ABSTRACT=Background: Mucormycosis commonly occurs in immunosuppressed patients with hematological diseases, which can be life-threatening. However, many cases are often misdiagnosed due to lack of specific clinical manifestations. Additionally, the traditional blood culture or serological testing ,with high false-negative rate, is time-consuming. So precise and timely diagnosis of infections is essential for the clinical care of infected patients.
Case Presentation: We report a 29-year-old Chinese male with acute myeloid leukemia (AML) who developed febrile neutropenia after the first course of induction chemotherapy. He received empirical antibiotics, which did not relieve his symptoms. No pathogen was detected by traditional microbiologic assays, while Mucor indicus was identified by metagenomic next-generation sequencing (mNGS) in the blood specimen. Liposomal amphotericin B (LAmB) was used, and then the patient’s temperature returned to normal. A fewer days later, abdominal computed tomography (CT) scan showed multiple liver abscesses, of which fluorescence staining, histopathology, along with mNGS identified the causative agent - M. indicus. Posaconazole was combined with LAmB as long-term antifungal throughout treatment. Finally, the patients received allogeneic hematopoietic stem cell transplantation successfully after controlled infection. Follow up one year after transplantation, the number of liver abscesses reduced to 1 and remained stable.
Conclusion: This report described the first case of an AML patient diagnosed with culture-negative disseminated infections caused by M. indicus leading to rare hepatic manifestations using mNGS of peripheral blood and liver biopsy. LAmB combined with Posaconazole was given in time, resulting in a favorable outcome. mNGS is a new method that assists in detecting the probable pathogen and increases the accuracy of identifying an etiology.