We report the case of a 10-year-old male patient with bone marrow aplasia secondary to Fanconi anemia who was initially admitted for febrile purulent tonsillitis (no throat culture was performed before antibiotic initiation). Despite several courses of broad-spectrum antibiotic therapy, the clinical course was marked by persistent fever and progressive right-sided orbitofacial cellulitis. Imaging revealed extensive involvement of the right maxillary sinus with orbital extension. The appearance of a necrotic black palatal lesion (eschar) in the setting of profound immunosuppression is highly characteristic, if not pathognomonic, of invasive mucormycosis. Liposomal amphotericin B (5 mg/kg/day) was initiated; however, surgical debridement could not be performed due to severe thrombocytopenia (platelet count of 1,000/mm³). The patient subsequently developed septic deterioration requiring intensive care management and ultimately died. This report highlights the diagnostic challenges and the rapidly progressive course in a severely immunocompromised pediatric patient and emphasizes the importance of early recognition and prompt initiation of antifungal therapy, although management may remain limited in patients with profound cytopenia in whom surgical treatment is not feasible.
Charaf et al. (2026) studied this question.