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Abstract

Three months after a kidney transplant, a man experienced an internuclear ophthalmoplegia. Magnetic resonance imaging found a punctuate hyperintensity of the brainstem. Afterwards, the patient presented with peripheral facial paralysis. A complete morphologic assessment showed an increase of the brainstem lesion, together with an excavated pulmonary nodule. Combination therapy with high-dose liposomal amphotericin B and voriconazole was begun for the putative aspergillosis. Owing to its atypical clinical presentation and negative detection of Aspergillus galactomannan antigen on sera, a biopsy specimen of the lung lesion was obtained. Histopathological and mycological investigations allowed the diagnosis of mucormycosis owing to Rhizopus microsporus. Accordingly, voriconazole was replaced with posaconazole. After 5 months, regression of the cerebral lesion was noted. Disseminated mucormycosis in solid-organ recipients is uncommon and mycological diagnosis is challenging. Mortality is high and is increased by diagnostic delay. Treating mucormycosis requires surgical debridement and appropriate antifungal therapy (usually intravenous liposomal amphotericin B). This report suggests that a combination of liposomal amphotericin B and posaconazole can be a therapeutic option in patients with a poor prognosis.

Therapy of Mucormycosis

“…Similarly, a study in neutropenic mice infected with R. oryzae found that amphotericin B and posaconazole dose combination did not prolong survival or decrease organ fungal burden to a greater extent than AMB monotherapy [ 79 ]. Human studies evaluating polyene-triazole combination for the treatment of mucormycosis are limited [ 76 , 80 , 81 , 82 , 83 , 84 , 85 ]. In one retrospective case series, 32 patients with hematological malignancies or aplastic anemia, and mucormycosis unresponsive to prior monotherapy (mainly with LAMB), were treated with combination of polyene and posaconazole [ 86 ].…”

Disseminated mucormycosis with cerebellum involvement due to Rhizomucor�pusillus in a patient with multiple myeloma and secondary myelodysplastic syndrome: A case report

“…The current report revealed that voriconazole treatment may increase the risk of Mucor infection within a short time in high-risk patients. Previous studies determined that using voriconazole, especially in patients with hematological malignancy and recipients of hematopoietic stem cell transplants, is associated with an increased incidence of mucormycosis (5,14). Mucormycosis infection can occur as a breakthrough infection during voriconazole treatment (15).…”

Phylogenetic analysis reveals two genotypes of the emerging fungus Mucor indicus, an opportunistic human pathogen in immunocompromised patients

“… 4 , 6 Disseminated mucormycosis is a very rare and life-threatening form of the disease. 7 , 8 The prognosis of disseminated mucormycosis is poor, with reported mortality rates in the neutropenic population ranging from 46% to 100%. 9 , 10 In this paper, we describe the existence of two genotypes, I and II, of the emerging pathogenic fungus Mucor indicus and a case of disseminated mucormycosis in a liver transplant patient caused by genotype I.…”