Pediatric Cancer–Associated Mucormycosis: A case series and review of the literature

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Background Mucormycosis is rare but aggressive invasive fungal infection in immunocompromised hosts, particularly children with hematological malignancies. Mortality remains high, especially in low-and middle-income countries (LMICs). We aimed to describe the clinical features, management, and outcomes of pediatric cancer–associated mucormycosis at a single centre and review published literature. Methods We retrospectively analysed all proven cases of mucormycosis in children with cancer managed at our tertiary pediatric oncology center over eight years (2017–2025) and reviewed all PubMed-indexed reports of proven pediatric cancer–associated mucormycosis published up to 30 October 2025. Eligible cases were ≤18 years with histopathologic or microscopic demonstration of Mucorales . Clinical presentation, management, and outcomes were summarized descriptively. Results Five institutional cases of proven mucormycosis occurred in children with acute lymphoblastic leukemia (ALL) during intensive chemotherapy. Infection sites included gluteal soft tissue, chest wall, brain, rhino-palatine, and orbital regions. All patients received liposomal amphotericin B, underwent surgical debridement, and received granulocyte support with temporary chemotherapy modification. All survived and continued leukemia therapy. Review of 73 published reports showed ALL as the predominant malignancy reported with this infection. Rhino-orbito-cerebral disease was most frequent (∼40%), followed by pulmonary (∼20%) and gastrointestinal (∼15%). Disseminated and gastrointestinal mucormycosis were associated with >80% mortality. Across the literature, survival improved modestly after 2015, correlating with earlier antifungal use, surgical intervention, and immune recovery. Conclusions Early antifungal initiation, aggressive surgical debridement, and timely neutrophil recovery remain the key determinants of survival in pediatric cancer–associated mucormycosis, forming pragmatic management pillars even in resource-limited settings.

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