IntroductionHematological malignancies (HMs) are a group of malignant clonal disorders that mainly affect the blood and hematopoietic tissues. They are broadly categorized into myeloid and lymphoid lineages \RL (1)\RL. Acute lymphoblastic leukemia (ALL) is classified as acute \RL lymphoid lineage disorder. All hematological malignancies engage the immune system and raise the chances of opportunistic infections mainly invasive fungal infections \RL)IFIs\RL( (2).Aspergillus and Mucorales species are emerged as increasingly relevant and most common agents responsible for highly lethal IFIs (3). The implementation of prophylaxis targetingCandida species in individuals with HMs has resulted in a higher occurrence of Aspergillosis compared to Candida infections (4).Aspergillus spp., the airborne microorganisms, can manifest in three principal forms: invasive, saprophytic, and allergic (5). AlthoughAspergillus fumigatus (A. fumigatus ) is the predominant species associated with disease, other species can also result in invasive infections in profound immunocompromised patients (6). Statistics indicate that invasive aspergillosis occurs in 4-15% of cases and has a mortality rate between 60% and 85% (7). Mucormycosis, a less frequent occurrence compared to aspergillosis, is a devastatingly angioinvasive fungal infection caused by ubiquitous filamentous fungi belonging to the Mucorales order (8). The main damage is rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, and disseminated, with a high mortality rate, estimated between 32% and 70% (9). Although lung is the most prevalent site of infection in patients with hematologic malignancies, rhino-orbito-cerebral mucormycosis (ROCM) is the most common form classically described in diabetic patients (10).Severe neutropenia (absolute neutrophil count below 500 cells/mm3) due to toxic antineoplastic chemotherapies and myelosuppressive agents or allogeneic hematopoietic stem cell transplantation (allo-HSCT) placing HMs at a higher risk of evolving life-threatening infections with few symptoms (11).Herein we report a case of concomitant acute invasive fungal rhinosinusitis (AIFR) and invasive pulmonary fungal infection withAspergillus and Mucoraceae species in a patient with pre B cell ALL. This research was approved by the Ethics committee of Isfahan University of medical sciences (IR.ARI.MUI.REC.1403.094), and written informed consent was obtained from the patient.

Abstract: Background: Pneumocystis pneumonia (PCP) incidence in acute myeloid leukemia (AML) patients have not been well described and some studies have shown the risk of this infection in these groups of patients. In this systematic review, we reviewed the published studies about PCP in AML to evaluate the PCP incidence and outcomes in these patients and then focuses on its immunological mechanism. Method: All articles reviewed in this collection are from recruited sites: PubMed and Embase databases. No time limit was considered for article searching. The following keywords were used: (“Pneumonia, Pneumocystis” OR Pneumocystis Pneumonia” OR “Pneumocystis jirovecii”), AND (“leukemia, myeloid, acute OR acute myeloid leukemia”). Our search strategy yielded 356 articles. After implementing the exclusion and inclusion criteria, the final papers were selected and reviewed. Result: By our search, 356 articles were found (316 in PubMed and 40 in Embase). After the implementation of inclusion and exclusion criteria, seven papers remained. A total of seven articles with a total number of 41 patients were included. Conclusion: Affected patients appear to have a clear resistance to PCP infection despite chemotherapy and bone marrow suppression due to the preservation of a specific immunological milieu in the lung. In fact, may be due to immunological stability of the lungs that remains intact. Further studies are needed.