Central nervous system mucormycosis after allogeneic hematopoietic stem cell transplantation: a clinical analysis of 6 cases
10.3760/cma.j.issn.1674-2397.2025.04.006
- VernacularTitle:异基因造血干细胞移植后并发中枢神经系统毛霉病6例临床分析
- Author:
Juan WANG
1
;
Yingling ZU
1
;
Ruirui GUI
1
;
Zhen LI
1
;
Wenli ZHANG
1
;
Xiangke XIN
1
;
Jian ZHOU
1
Author Information
1. 河南省肿瘤医院血液科，郑州 450008
- Publication Type:Journal Article
- Keywords:
Allogeneic hematopoietic stem cell transplantation;
Invasive fungal infection;
Central nervous system;
Mucormycosis
- From:
Chinese Journal of Clinical Infectious Diseases
2025;18(4):290-295
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics and treatment outcomes of central nervous system（CNS）mucormycosis following allogeneic hematopoietic stem cell transplantation（allo-HSCT）.Methods:Clinical data of 6 patients diagnosed with CNS mucormycosis after allo-HSCT at Henan Cancer Hospital between January 2020 and December 2024 were retrospectively collected. The patients' clinical manifestations，laboratory findings，imaging features，treatment regimens，and outcomes were analyzed.Results:The incidence of CNS mucormycosis post-allo-HSCT was 0.7%（6/851）. The main clinical manifestations included impaired consciousness（5 cases），convulsions（3 cases），headache（2 cases），hemiplegia（1 case），ptosis（1 case），and mydriasis with sluggish light reflex and incomplete eye closure（1 case）. The median time from transplantation to the onset of neurological symptoms was 138 days（94-572 days）. Metagenomic next-generation sequencing（mNGS）of cerebrospinal fluid identified Rhizopus spp.（2 cases）， Rhizomucor spp.（2 cases），and Absidia spp.（2 cases）. Cranial MRI performed in five patients revealed multiple mass or patchy lesions in various regions；one patient underwent cranial CT，which showed patchy hypodense lesions in multiple areas. All patients received antifungal therapy，with 2 cases receiving combined intrathecal injection of amphotericin B liposomes；five patients died，and one survived. Conclusions:CNS mucormycosis is a rare but severe complication after allo-HSCT. Its clinical and radiological features are non-specific，posing diagnostic challenges. Intravenous administration of liposomal amphotericin B at full dosage，combined with intrathecal injection，may improve treatment efficacy.
