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Mucormycosis has not been described previously as a cause of carotid-cavernous sinus fistula or mycotic aneurysm, certainly not coexisting in the same patient. CT and angiographic findings are presented in a patient who had a fistula, mycotic aneurysm, and associated cerebral vasculitis.
We present the first case of cutaneous mucormycosis reported in a patient who had undergone a heart transplant operation. This appeared to be a localized infection without a predisposing local factor such as a surgical adhesive and without evidence of dissemination. Prompt treatment with intravenous amphotericin B resulted in an apparent cure.
A case of diabetic keto-acidosis complicated by rhinocerebral mucormycosis is described. Early diagnosis, control of the diabetes, aggressive surgical debridement, and systemic antifungal therapy resulted in a successful outcome.
The authors report the case of 5 1/2 year-old boy with insulin-dependent diabetes mellitus revealed during the induction therapy of an acute leukemia of the mixed type, and who presented with an unusual type of pulmonary fungal infection: mucormycosis. It had a favourable outcome with surgical excision preceded and followed by amphotericin B treatment.
Evidence suggests that neutrophils are important in host defenses against invasive aspergillosis and mucormycosis, although hyphae in these lesions are too large to be phagocytized. Interactions of neutrophils with hyphae of Aspergillus fumigatus and Rhizopus oryzae were studed in vitro. Light and electron microscopic observations indicated that neutrophils attached to and spread over the surfaces of hyphae, even in the absence of serum. This was followed by dramatic morphologic changes which suggested severe damage and probably death of hyphae. An assay of neutrophil-induced reduction of uptake of radioisotopes was used to quantitate damage to the fungi by neutrophils from normal subjects. Damage to hyphae was inhibited by a variety of compounds which are known to affect neutrophil surface functions, motility, and metabolism. Use of inhibitors of oxidative microbicidal mechanisms of neutrophils indicated the central importance of these mechanisms in damage to hyphae. Inhibitors of neutrophil cationic proteins altered damage only to Rhizopus. Damage to hyphae by lysozyme suggested that it may play a secondary role in the neutrophil, primarily against Aspergillus. This new nonphagocytic mechanism may play an important role in host defenses against these and other hyphal forms of fungi.
A biliary drainage catheter that traversed the right pleural space was associated with unilateral pleural infection by an unidentified zygomycete that caused pleural mucormycosis. The fungal infection was confined to the pleura and immediately subjacent lung. We interpreted these findings as a fungal wound infection that unfortunately involved a major body cavity.
A case of orbital zygomycosis, probably mucormycosis, histologically demonstrated was observed in a healthy host. The etiologic agent could not be identified because of the unsuccessful cultures. No clinical antecedent allowed us to suppose that an immunological deficiency statement was present. It seemed that the fungus did not penetrates by the classical nasal and sinusal pathways. The fungus inoculation probably resulted from a subocular traumatism. The ketoconazole treatment, the only one possible in our case, was efficient.
A patient with septic abortion complicated initially by hepatorenal failure and later by rhinocerebral phycomycosis (mucormycosis) is described. It is believed that the outcome was fatal because the patient was diabetic and had been extensively treated with antibiotics.
Submandibular and/or disseminated zygomycosis (mucormycosis) was diagnosed in 3 feeder pigs from 2 farrow-to-finish farms. Affected pigs were stunted and unthrifty. Each pig had a large unilateral submandibular granuloma replacing the mandibular lymph node on the affected side. Two pigs had disseminated lesions. One had an abscess on the serosa of the stomach; another had abscesses scattered throughout the liver and mesenteric lymph nodes. Impression smears were made of several masses and stained with blue-black ink. Examination of smears by light microscopy revealed coarse, infrequently septate, irregularly branching, mucoraceous fungi typical of a Zygomycete. Histologic examination of the submandibular masses revealed granulomas containing large numbers of mixed inflammatory cells, including giant cells. Mesenteric lymph nodes and liver abscesses had necrotic cores surrounded by fibrous capsules infiltrated by mixed inflammatory cells. Hyphae of a mucoraceous fungus were scattered throughout all masses. The 2 pigs submitted alive had marked serum hypoproteinemia, including hypoglobulinemia.
Acute gastric zygomycosis (mucormycosis) was diagnosed in four 6- to 7-day-old pigs with large venous infarcts in the gastric fundus. Two pigs were from one farm where several dams had developed fever at parturition and most of their litters had died. The other 2 pigs, from separate farms, had diarrhea that was unresponsive to broad-spectrum antibiotic therapy. Histologically there was severe hemorrhagic, ulcerative gastritis associated with numerous transmurally invading, mucoraceous fungi. The discussion includes speculation on the pathogenesis of this lesion in neonatal pigs.
Two intravenous amphetamine abusers had fatal, rapidly progressive cerebral mucormycosis with abscess formation in the presence of absolute lymphopenia. Postmortem examination confirmed the primary nature of the fungal cerebritis, documented by postmortem culture and histology. The clinical and pathologic features of these cases are compared to previously reported occurrences of primary fungal cerebritis (and abscess) among intravenous drug abusers, including cocaine users. Primary fungal cerebritis associated with intravenous abuse of stimulant drugs is discussed as a possible variant of the acquired immunodeficiency syndrome.
Two fatal cases of rhinocerebral mucormycosis with fungal invasion and occlusion of the internal carotid artery are described. Review of the literature reveals 35 similar cases of whom only 6 survived. Emphasis is placed on the need for early diagnosis and prompt therapy which consists of correction of the underlying disease, aggressive surgical debridement, and amphotericin B.
We report a new case of primary pulmonary mucormycosis. The radiographic evidence and anatomopathological facts demonstrate an intra-cavitary mycetoma of Fowler associated with a chronic pneumonia in the left basal segment. The patient was not immunosuppressed but had undergone a left upper lobectomy 25 years before. This appears to be the first case in which a serological study has confirmed the diagnosis.
We report a case of rhinocerebral mucormycosis in a patient with poorly controlled diabetes mellitus. The pathology, clinical features, diagnosis and treatment of this disorder are discussed.
The clinical and pathological features of two patients who died of rhinocerebral mucormycosis are described. The cases illustrate two of the major mechanisms by which the brain may be affected in this condition. Although the diagnosis is often made only at post mortem the clinical features are often distinctive enough to allow recognition of this disease during life.
We report a case of rhinocerebral mucormycosis in a patient with acute lymphoblastic leukaemia undergoing remission induction therapy. The diagnosis was suspected on the characteristic clinical features and confirmed by histology and culture of infected tissue obtained by biopsy. Treatment was successful because of early institution of antifungal therapy, repeated surgical debridement and established of remission in the underlying disease.
Two cases of rhinocerebral mucormycosis are reported to draw attention to this fulminating fungal disease. Both patients had diabetes, and presented with a rapidly progressive orbital apex syndrome.
Mucormycosis in infants is exceedingly rare, and over 90% of reported cases have been fatal. A case of a dehydrated three-week-old infant with involvement of the palate, maxilla, orbit, and brain is described with extensive laboratory and radiological investigation. This infant survived after surgical debridement and therapy with amphotericin B.