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A case of mucormycosis in a 82-year old woman is reported. In spite of an early diagnosis, a surgical intervention and the antimycotic treatment with Miconazol-Sodium (Daktar [R]) and Amphothericin B "Squibb" (R) could only prolonge the bad prognosis of this infection. The pathogenesis, the typical, in most cases letal fungal infection and its therapy is discussed.
An unusual case of mucormycosis is presented: a cutaneous form characterized by an extension to the soft tissues of the face with a noticeable involvement of facial lymph nodes. The successive CT studies enable the description of the lesions and their follow-up.
The pathologic examination of the brain of a pet cat, suspected of rabies, showed lesions of mucormycosis. The causal fungus, Mucor (Rhizomucor) pusillus was isolated and identified. The authors describe the lesions produced, the experimental pathogenicity for the rabbit and the morphologic and physiologic characteristics of the isolate.
Opportunistic infections remain one of the penalties of the immunosuppression required for successful outcome of organ transplantation. We report the case of a 51 year old woman who, after having received combined kidney and pancreas transplants, developed invasive mucormycosis in the gastrointestinal tract. The hallmarks of successful management of this rare but potentially fatal fungal infection are radical surgical debridement, aggressive antimycotic therapy and control of any underlying diseases. Diagnostic and therapeutic approaches are discussed.
Mucormycosis is a fungal infection, the most frequent form begins in the nose and the paranasal sinuses and can rich the brain. It's a fulminant and often fatal disease, not well known to specialists. The authors present the case of the patient cured with medical (fluconazolo) and surgical therapy where resolved the disease.
A 29 year old male, admitted with diabetic keto-acidosis, was found to have rhinocerebral phycomycosis (mucormycosis) involving the left eye and the left hard palate with perforation into the maxillary antrum. Despite late diagnosis, full recovery was obtained following intravenous Amphotericin B (total dose : 3.015 gm in 4 months) and extensive surgery (debridement and unilateral eye enucleation). The circumstances of onset of the disease and its clinical characteristics are discussed; the main features of its management are analyzed.
80-year-old female was admitted to our hospital because of pancytopenia. Her peripheral and bone marrow examinations were performed. According to the criteria of FAB classification, the diagnosis was myelodysplastic syndrome (refractory anemia with excess of blasts in transformation). Etoposide was administered to decrease leukemic blasts. However, she still had high fever and increasing of CRP. Hematological data also showed the increasing of WBC count, blast cells, and LDH enzyme. Antibiotics and anti fungal drugs were also not effective. She died of respiratory failure, although the cautions and extensive treatment was tried. Autopsy findings revealed proliferation of mucor in the mucosa of stomach. So, we reported here a very rare case of gastric mucormycosis, localizing exclusively in the stomach which was difficult to diagnose while she was alive.
A 56-year-old man with bronchial asthma and diabetes was admitted with massive hemoptysis and thick-walled cavity in the right middle lung field on chest X-ray films. He had been treated with antibiotics for eight months under the diagnosis of lung abscess before his admission. After occlusion of the bronchial arteries with metallic coils, bronchofiberscopy was performed disclosing the obstruction of right B3b. Microscopic examination of bioptic material and bronchial brushing smear taken from right B3b yielded numerous broad, nonseparate hyphae. Right middle and lower lobectomy were performed under a diagnosis of chronic pulmonary mucormycosis. The patient was recovered and discharged on 55 th days after operation.
A case of rhino-orbitocerebral mucormycosis is presented, illustrating the serious nature of this disease. Clinical features and their pathological correlations are demonstrated. The need for a high index of clinical suspicion, and an early biopsy of the affected area is emphasized so that the benefits of early diagnosis and therapy may be gained.
The Authors report a case history of rhinocerebral mucormycosis in a patient with chronic lymphatic leukaemia and recommend that therapy be based on three different approaches: treatment for the underlying disease, systematic antifungal treatment with Amphotericine B, and surgical asportation of diseased tissue. They affirm that results may be surprisingly successful, even in cases with signs of orbital-cerebral involvement which are indicative of a poor prognosis and the concomitant presence of a serous disease such as leukaemia.
Between 1989 and 1992 we had two cases of mucormycosis. The first patient presented with left hemiplegia: radiologic studies showed a right sphenoidal sinus mass, cerebral ischaemic infarction and occlusion of the right carotid artery. The second patient was seen with an abscess of the hard palate after long term steroid therapy. CT scan showed a soft-tissue mass occupying the maxillary sinus, which had eroded its walls and spread to palate, orbit and ethmoidal cells. We have emphasised the presence of hyperglycemia in both cases, the marked tendency of this lesion to invade blood vessels, and the good results obtained by combining liposomal amphotericin B with radical surgical debridement.
An unusual pathway of local spread of rhinocerebral mucormycosis is presented with MR and pathologic correlation. Perineural extension, proved with pathology, followed the trigeminal nerve to the pons. Enhancement of the nerve was seen on MR.
Mucormycotic infections caused by fungi of the families Rhizopus, Mucor or Absidia are rare and usually associated with diabetes or immunosuppression. We describe a patient with invasive necrotizing cutaneous mucormycosis caused by Absidia corymbifera shortly after allogeneic BMT. The infection was successfully treated with surgical debridement and liposomal amphotericin B for 6 weeks. Recognition of these rare infections requires a high index of suspicion. These patients should be evaluated with tissue biopsy and cultures and treated without delay.
Six cases of rhinocerebral mucormycosis were seen over a 6-year period. The disease, its diagnosis and treatment are described by analyzing three representative cases.
A 47-year-old uncontrolled diabetic presented with proptosis, pain, immobility of the globe, and a perforated corneal ulcer. The clinical impression of mucormycosis was erroneous. Hemophilus aegyptius was grown from the orbit, the vitreous and oropharynx. This is believed to be the first report of panophthalmitis due to this organism.
Infectious complications after heart transplantation remain a major cause of morbidity and mortality. While many viral, bacterial, and protozoal infections can be successfully treated, fungal infections continue to be challenging. Mucormycosis is a rare infection in heart transplant recipients; however, mortality is exceedingly high. We report a case of cavitary Rhizopus lung infection 2 months after cardiac transplantation. The infection was complicated by inadvertent exposure of the pleural cavity to the fungus during surgical resection. Therapy consisted of standard systemic amphotericin B, surgical excision, and for the first time, the use of adjuvant intrapleural amphotericin B. Cure was achieved with no clinical or radiological evidence of disease at 3 months follow-up. Rhizopus pulmonary infection is a rare complication of cardiac transplantation. Treatment consists of the triad of systemic anti-fungal therapy, surgical resection, and control of any underlying predisposing diseases. Adjuvant intrapleural amphotericin B use could also be considered in patients with fungal pneumonias and evidence of chest wall and/or pleural cavity involvement.
The observation of pulmonary mucormycosis occurring in a patient presenting with aplasia induced therapeutically during treatment for acute myeloblastic leukaemia, has led to a review of the characteristics of this rare opportunistic fungal infection: it occurs in a particular condition; the clinical manifestations are characterised by the thrombotic character and the rapidly necrosing nature of the histological lesions; the diagnosis is usually very difficult to make and is linked to the rarity of the pathology and the frequently negative mycological specimens apart from tissue biopsies; the value of a medicosurgical therapeutic strategy on which the prognosis of the infection depends.
A case of mucormycosis in an African gray parrot (Psittacus erithacus) involving air sac and kidney is described. The causal fungus, Absidia corymbifera, had produced sporangia in the air-sac lesion.