From Cellulitis to Bifocal Forearm Osteomyelitis: An Exceptional Presentation Of Invasive Mucormycosis in a Child with Acute Lymphoblastic Leukemia, a Case Report
- 1Department of Pediatric Oncology, Anti-Cancer Center of Draa Ben Khedda, Tizi-Ouzou, Algeria
- 2Faculty of Medicine, Amar TELIDJI University, Laghouat, Algeria
- 3Department of Mycology, Pasteur Institute of Algeria
Abstract
Invasive mucormycosis is a rare but life-threatening fungal infection that primarily affects immunocompromised patients. We report the case of a 6-year-old boy with B-cell acute lymphoblastic leukemia who developed rapidly progressive necrotizing cellulitis of the left forearm during induction chemotherapy. Despite broad-spectrum antibacterial therapy, the lesion evolved with deep soft-tissue extension and bifocal osteomyelitis involving the ulna and the radius. Definitive diagnosis was established by histopathological examination of deep surgical specimens demonstrating broad, aseptate hyphae consistent with Mucorales. Management required aggressive surgical debridement and liposomal amphotericin B. The clinical course progressed to chronic osteomyelitis with residual wrist deformity; however, sustained bone marrow remission was maintained. Because intensive myelosuppressive chemotherapy was temporarily contraindicated due to active invasive fungal infection, blinatumomab was administered as a bridging immunotherapeutic strategy. This case highlights the importance of early deep tissue sampling in refractory cellulitis in neutropenic children and underscores the role of combined medical–surgical management and adapted oncologic therapy in improving outcomes.
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BibTeX
@article{iddir2026from,
title = {{From Cellulitis to Bifocal Forearm Osteomyelitis: An Exceptional Presentation Of Invasive Mucormycosis in a Child with Acute Lymphoblastic Leukemia, a Case Report}},
author = {Samir Iddir and Brahim Lounis and Zakia Batoul Benlahrech and Zohra Hamroune and Khadidja Haddad},
journal = {Clinical Pediatric Hematology-Oncology},
year = {2026},
month = oct,
doi = {10.15264/cpho.2026.33.2.85},
url = {https://doi.org/10.15264/cpho.2026.33.2.85},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - From Cellulitis to Bifocal Forearm Osteomyelitis: An Exceptional Presentation Of Invasive Mucormycosis in a Child with Acute Lymphoblastic Leukemia, a Case Report
AU - Samir Iddir
AU - Brahim Lounis
AU - Zakia Batoul Benlahrech
AU - Zohra Hamroune
AU - Khadidja Haddad
PY - 2026
DA - 2026/10/30
JO - Clinical Pediatric Hematology-Oncology
DO - 10.15264/cpho.2026.33.2.85
UR - https://doi.org/10.15264/cpho.2026.33.2.85
AB - Invasive mucormycosis is a rare but life-threatening fungal infection that primarily affects immunocompromised patients. We report the case of a 6-year-old boy with B-cell acute lymphoblastic leukemia who developed rapidly progressive necrotizing cellulitis of the left forearm during induction chemotherapy. Despite broad-spectrum antibacterial therapy, the lesion evolved with deep soft-tissue extension and bifocal osteomyelitis involving the ulna and the radius. Definitive diagnosis was established by histopathological examination of deep surgical specimens demonstrating broad, aseptate hyphae consistent with Mucorales. Management required aggressive surgical debridement and liposomal amphotericin B. The clinical course progressed to chronic osteomyelitis with residual wrist deformity; however, sustained bone marrow remission was maintained. Because intensive myelosuppressive chemotherapy was temporarily contraindicated due to active invasive fungal infection, blinatumomab was administered as a bridging immunotherapeutic strategy. This case highlights the importance of early deep tissue sampling in refractory cellulitis in neutropenic children and underscores the role of combined medical–surgical management and adapted oncologic therapy in improving outcomes.
SN - 2233-5250
SN - 2233-4580
ER -