Clinical characterization of cutaneous mucormycosis in patients receiving Bruton tyrosine kinase inhibitor therapy with Ibrutinib: A new case report and comparative discussion

Abstract

Introduction

Mucormycosis are invasive fungal infections caused by fungi of the order Mucorales that classically affect profoundly immunosuppressed patients. Recently, cases have emerged in patients receiving Bruton tyrosine kinase inhibitors like Ibrutinib, used for chronic lymphocytic leukemia (CLL).

Methods

We report a 58-year-old man with CLL on Ibrutinib and Venetoclax who developed a rapidly progressing necrotic ulcer on his leg after minor trauma. Histopathology revealed angioinvasive, non-septate hyphae; Rhizopus spp. was confirmed by culture. He was treated with surgical debridement, liposomal amphotericin B, and isavuconazole, with good outcome. We also reviewed published cases of cutaneous mucormycosis in Ibrutinib-treated patients.

Results

Including our case, seven patients were identified. Most presented with single necrotic limb lesions after minor trauma. Median age was 69.5 years; median Ibrutinib exposure was 3 years. Liposomal amphotericin B was the most used antifungal; surgery was performed in over half of the patients.

Conclusions

Cutaneous mucormycosis is an emerging complication in Ibrutinib-treated patients. Early diagnosis and combined antifungal and surgical treatment are crucial.