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PubMedDate not supplied

MR findings in rhinocerebral mucormycosis.

A case of rhinocerebral mucormycosis evaluated by magnetic resonance (MR) imaging is presented, with inflammatory changes in the paranasal sinuses and orbit. Extension of the infection into the cavernous sinus, with cavernous sinus thrombosis and internal carotid artery narrowing, was well demonstrated on pre- and postgadolinium MR images. Infarctions in the anterior choroidal artery distribution suggested intracranial invasion of basal arteries, and watershed distribution infarctions attested to the tenuousness of flow through a narrowed cavernous carotid artery. Magnetic resonance effectively demonstrated the wide array of findings possible in rhinoorbitocerebral mucormycosis.

Adult↗

PubMed1986

Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases.

Mucormycosis is an uncommon, frequently fatal, fungal infection which rarely arises in otherwise healthy people (15, 18, 92). An underlying disease, frequently diabetes mellitus, is almost always present. It appears stereotypically in different anatomic sites: paranasal, rhinoorbital, rhinocerebral, cerebral, pulmonary, and gastrointestinal areas; and in the soft tissue of the extremities. It can also appear as disseminated disease. Tissue invasion by the hyphae of mucormycosis must be seen microscopically to establish the diagnosis, but culture is required to identify the fungal species involved. A study of 33 cases seen in one hospital over five decades suggests that the incidence of this infection is increasing. There has been a dramatic improvement in outcome, which has been paralleled by a major shift from postmortem to premortem diagnosis. Premortem diagnosis gives the opportunity for metabolic stabilization, surgical excision, and amphotericin-B therapy appropriate to this disease.

Adolescent↗

PubMed1993

Cryptococcus albidus and mucormycosis empyema in a patient receiving hemodialysis.

C albidus and mucormycosis were cultured simultaneously from the pleural space of a patient with end-stage renal disease receiving long-term hemodialysis. There have been only nine previous reports of infection with C albidus, with only one involving the lung. This organism has never before been isolated from the pleural space, and none of the previously reported cases included a coinfection with mucormycosis. We have reviewed and compared all known cases of infection with C albidus.

Adult↗

PubMedDate not supplied

Successful treatment of mucormycosis in the pulmonary artery after cardiac surgery.

Mucormycosis endocarditis after cardiovascular surgery is a rare and usually fatal complication. Here, we report one case of mucormycosis occurring in the pulmonary artery and the residual patent ductus arteriosus (PDA) in a 9-year-old girl, who had been successfully cured with the combination of the emergent surgical removal of infected tissues and the subsequent antifungal drug therapy.

Anti-Bacterial Agents↗

PubMed2005

Cutaneous mucormycosis in a patient with acute lymphocytic leukemia.

We describe a patient with invasive necrotizing cutaneous mucormycosis caused by Rhizopus oryzae. The patient, who had been suffering from acute lymphocytic leukemia (ALL) for eight months, had erythema and necrosis surrounded by swelling on the dorsum of his left hand. Debridement was performed, and microscopic examination of the obtained specimens revealed mucormycosis. Because amphotericin B was ineffective, amputation at the left shoulder joint was performed. Bone marrow transplantation (BMT) was successfully carried out 22 days after surgery. However, the patient died 162 days after the BMT due to progression of the ALL. Patients such as the present one should be evaluated promptly by tissue biopsy and appropriate cultures, so that vigorous treatment can be started without delay. Where necessary, amputation should be performed.

Adult↗

PubMed2005

The first case of cutaneous mucormycosis caused by Rhizopus azygosporus.

A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus.

Amphotericin B↗

PubMed1995

Mucormycosis: experience with 10 patients.

Rhinocerebral mucormycosis is a fulminating, devastating fungal disease, usually associated with debilitating diseases such as diabetes mellitus, leukaemia and immunosuppressive conditions. Ten patients with this rare disease have been treated over the past 14 years at the Beilinson Medical Centre. Nine patients had an underlying debilitating disease and one patient had latent diabetes mellitus which was diagnosed only after presentation of mucormycosis. Only two of the 10 patients survived. Early aggressive surgical debridement, together with amphotericin B and correction of underlying metabolic acidosis were found to be important factors associated with survival.

Adult↗

PubMed2006

Non-fatal gastric mucormycosis in a renal transplant patient and review of the literature.

Mucormycosis is historically associated with substantial morbidity and carries a very high mortality in renal transplant patients. The common sites of involvement include cerebral, pulmonary, gastrointestinal, or disseminated lesions. We report the successful outcome of gastric mucormycosis along with Strongyloides stercoralis infection in a renal transplant patient, who has survived for 5 years. We also review the literature.

Adult↗

PubMed2005

Disseminated acute concomitant aspergillosis and mucormycosis in a pony.

A 6-year-old female pony died after 2 days of prostration. Clinical signs included hyperthermia and abnormal pulmonary auscultation sounds. Necropsy revealed diffuse severe necrohaemorrhagic colitis and splenitis, multiple visceral ecchymoses, petechial haemorrhages in the brain and lungs. Microscopical examination showed acute necrohaemorrhagic colitis, encephalitis, pneumonia and splenitis associated with fibrinoid vasculitis, thrombosis and fungal hyphae within and around vessels. Immunohistologically, concomitant aspergillosis (caused by Aspergillus fumigatus) and mucormycosis (causde by Absidia corymbifera) were identified in the colonic and pulmonary lesions, whereas pure mucormycosis was observed in cerebral and splenic lesions. Dual mycotic infections are very rarely described, and the present case emphasizes the need of immunohistochemistry in order to obtain a clear-cut diagnosis of mixed fungal infections.

Acute Disease↗

PubMed1997

Survival after gastrointestinal mucormycosis in a neonate.

Gastrointestinal mucormycosis has been reported more frequently in adults than in children. Due to the high mortality diagnosis is usually made at autopsy. Only one case of a neonate surviving this disease has been described. We report a premature infant presenting clinically with enterocolitis but lacking the radiological characteristics of necrotizing enterocolitis (NEC) Gastrointestinal mucormycosis was diagnosed on the histological specimen. The infant survived after surgery and 6 weeks of antifungal treatment. A high level of suspicion and early surgical intervention are necessary to make the correct diagnosis and commence appropriate treatment.

Anastomosis, Surgical↗

PubMed1992

Pulmonary mucormycosis with fatal massive hemoptysis.

A case of pulmonary mucormycosis in a 57-year-old woman with acute promyelocytic leukemia (APL) who died of massive hemoptysis is reported. Chest radiography revealed changes that began with a small focal infiltration and progressed to a large round nodule with cavity formation. Postmortem examination showed the nodule to be composed mainly of infarcted lung tissue with saprophytic growth of Mucor. An adjacent proximal branch of the left pulmonary artery was thrombosed with mucoraceous hyphae, and it had ruptured into the cavitary space around the necrotic tissue and then into a conducting bronchus. In general, both fatal massive hemoptysis and cavity formation are rare in pulmonary mucormycosis. In our present case, the histological findings suggested that both phenomena were closely related to the pulmonary infarction caused by Mucor invasion of the pulmonary artery.

Female↗

PubMed2000

Mucormycosis manifesting as proptosis and unilateral blindness.

A 51-year-old woman presented to the emergency department (ED) of another institution with sudden onset of blindness in the left eye. The patient was found to have no light perception in the left eye and a marked chemosis occurring several days after a fall. She was transferred to the hospital for ophthalmologic evaluation. Upon careful history and physical examination, the diagnosis of rhinocerebral mucormycosis was considered and urgent ophthalmology and otolaryngology consults were obtained. The patient underwent extensive surgical debridement and pharmacologic treatment. The diagnosis was confirmed by pathological specimens. In this case report, the clinical presentation, pathogenesis, diagnostic workup, and ED management of mucormycosis are discussed, highlighting the possible diagnostic and therapeutic pitfalls that are most pertinent to the emergency physician.

Accidental Falls↗

PubMed1999

Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: case report and literature review.

Emphysematous gastritis is an often lethal, rare clinical entity referring to air bubbles in the wall of the stomach produced by gas-forming bacteria. Invasive gastrointestinal mucormycosis is an unusual clinical presentation of this invasive fungal disease. We report the first case of invasive gastric mucormycosis occurring with emphysematous gastritis, and review the literature regarding both of these clinical entities.

Aged↗

PubMed1990

A case of cutaneous mucormycosis in Shanghai, China.

A 34-year-old female farmer suffered from localized cutaneous mucormycosis for 17 years. At the first admission, the lesion was a dull red plaque, about 7 x 9 cm in size with ulcerations, surrounded by some nodules on the dorsum of her right hand. General examination did not reveal abnormal findings except the skin lesion. Direct examination of skin scrapings in 10% KOH revealed broad, sparsely septate, branching hyphae. Histopathology showed many intradermal granulomata and microabscesses as well as mycelial elements comprising broad, distorted, ribbon-like strands. Some of them were phagocytized by multi-nucleated giant cells. Cultures revealed rapidly growing yellow colonies on Sabouraud dextrose agar medium at 25 degrees C. Sporangiophores branched in sympodia and the sporangia were globose, 35-60 microns in diameter. Their walls were deliquescent, but some of them were rather persistent. Columellae were mostly globose, 12-17 microns in diameter, up to 35 microns with collars. Sporangiospores were mainly ellipsoidal, 1.5-2.5 x 3-5 microns in size, but sometimes highly variable in size and shape. The maximum growth temperature of the isolate was 37 degrees C. The pathogenic organism isolated was tentatively identified as Mucor lusitanicus, which, as far as we know, has not been reported as a causative agent of cutaneous mucormycosis.

Adult↗

PubMed1996

Gastric mucormycosis due to Rhizopus oryzae in a renal transplant recipient.

Gastric mucormycosis is a rare disease with a reported fatal outcome of 98%. Manifestations range from colonization of peptic ulcers to infiltrative disease with vascular invasion and dissemination. In our renal transplant patient a deep gastric ulceration infected with Rhizopus oryzae (class Zygomycetes), which is known to be an agent of mucormycosis, was diagnosed in the early posttransplant period after antirejection therapy. The infection was successfully managed with amphotericin B and omeprazole.

Adult↗

PubMed2004

Disseminated mucormycosis in a patient with acute myeloblastic leukemia misdiagnosed as infection by Enterococcus faecium.

Mucormycosis is a rare complication in cancer patients. This report presents the case of a acute myeloblastic leukemia patient who developed an ascending paralysis due to disseminated mucormycosis. The presentation was unusual because the early symptoms were fever and pain, and the disease was misdiagnosed because of a concomitant infection by Enterococcus faecium.

Aged↗

PubMed1979

Rhizopus rhizopodiformis: emerging etiological agent of mucormycosis.

Mucormycosis is caused principally by members of the genus Rhizopus, especially R arrhizus and R. oryzae. Infection attributable to R. rhizopodiformis has rarely been documented. Of 13 cases of mucormycosis diagnosed during a 4-year period (1974 to 1978) at The Mount Sinai Hospital, 6 cases, occurring within 9 months, were caused by R. rhizopodiformis. The six isolates were identified mainly by: growth at 50 degrees C; production of short, sometimes branched, sporangiophores arising from opposite rhizoids; elongated columellae; and small spherical-to-elliptical, smooth-to-finely striated sporangiospores. The possibility that this explosive occurrence of R. rhizopodiformis at our institution was because of nosocomial acquisition was strongly supported by the recovery of this same mycotic agent from adhesive bandages used in the cardiac intensive care unit, where a patient developed subcutaneous R. rhizopodiformis infection after cardiac surgery. The invasive potential of R. rhizopodiformis was manifested by the extensive subcutaneous and systemic infections in each of the six patients, three of whom developed antibody against this mucormycotic agent.

Adult↗

PubMed1989

Orbital mucormycosis with retinal and ciliary artery occlusions.

A 61-year-old man presented with acute, painful loss of vision in the left eye due to a central retinal artery occlusion. Fluorescein angiography confirmed the central retinal artery occlusion and also identified a nasal posterior ciliary artery occlusion. CT scanning revealed a left medial orbital mass with adjacent ethmoid sinusitis. Transnasal ethmoid biopsy disclosed mucormycosis. A left external ethmoidectomy, maxillectomy, and orbital exploration were performed, after which the patient was treated with daily intravenous amphotericin B for six weeks. Coexistence of retinal and nasal posterior ciliary artery occlusion due to mucormycosis may relate to their common origin from the ophthalmic artery. Treatment without exenteration was successful.

Arterial Occlusive Diseases↗