Coexistence of Mucormycosis and Granulomatosis With Polyangiitis: A Diagnostic and Therapeutic Challenge

Abstract

Mucormycosis is a destructive, necrotizing, and potentially fatal fungal disease that usually affects immunocompromised or diabetic patients. Granulomatosis with polyangiitis (GPA), previously known as Wegener’s granulomatosis is a rare, aseptic necrotizing, granulomatous vasculitis affecting small- to medium-sized vessels, resulting in systemic manifestations. Here, we present a case of a 46-year-old gentleman with overlapping features of mucormycosis and GPA, that was successfully treated with isavuconazole monotherapy.

Two Rare Diseases, One Patient: A Case Report of Mucormycosis and Granulomatous Polyangiitis

“…Mucormycosis can mimic relapse or progression of GPA. It is crucial to timely diagnose and treat mucormycosis infection in order to prevent a disseminated disease with a poor prognosis [ 4 ]. There are very few reported cases of mucormycosis in patients with GPA [ 5 , 6 ].…”

“…In our case, patient was successfully managed with debridement and conservative management. However, there have been cases of GPA with mucormycosis requiring otorhinolaryngological surgical procedures [ 4 ]. Because both diseases have overlapping symptoms and catastrophic outcomes in untreated individuals, a comprehensive workup is required to distinguish both conditions and treat them effectively.…”

“…Starting immunosuppressive treatment for GPA without simultaneously treating the fungal infection can result in disseminated mucormycosis, which has a poor prognosis. As a result, a thorough evaluation is critical for a successful outcome [ 4 ].…”

“…Surgical debridement of necrotic tissue and amphotericin B (AMB) is the treatment of choice for mucormycosis [1,9]. In case of AMB toxicity or preexisting kidney disease, isavuconazole and posaconazole can be used [4,9]. Blood vessel occlusion and thrombosis are potential complications of mucormycosis.…”

Pulmonary Artery Aneurysm Associated With Aspergilloma in a Patient Diagnosed With Granulomatosis With Polyangiitis

“…GPA is a rare necrotizing granulomatous vasculitis that affects small- to medium-sized vessels. It commonly involves the upper respiratory tract, lungs, and kidneys, with isolated sinonasal disease present in 25% of cases [ 3 ]. GPA belongs to a group of ANCA vasculitis, which also includes eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis [ 4 ].…”