Disseminated Mucormycosis with Positive Aspergillus Galactomannan

Abstract

We describe a case of disseminated mucormycosis (Apophysomyces elegans) diagnosed on autopsy, in a man who had been working in construction with undiagnosed neutropenia from hairy-cell leukemia, which is rarely associated with invasive mold infections. Galactomannan values in both blood and bronchoalveolar lavage were strongly positive. There is an unmet need for accurate noninvasive fungal diagnostic tests. Detailed history, including occupational exposures, can be more informative than laboratory workup.

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

“…An important observation was that almost half of all patients with CAPA had corticosteroid exposure ( Table 1 ). Steroids are increasingly recognized as an important risk factor for invasive mold infections [ 11 , 12 , 51 , 52 ], and more specifically mixed invasive mold infections [ 51 , 52 ], even in patients with no other risk factors [ 11 , 52 ]. Bartoletti et al, also pointed out that the high incidence of CAPA in their cohort could be associated with high utilization of corticosteroids and tocilizumab for COVID-19.…”

“…It is plausible that some of these cases had previous Aspergillus spp. airway colonization that progressed to clinical infection, since use of broad-spectrum antibiotics and especially corticosteroids, common in critically ill patients, promotes Aspergillus growth and tissue invasion [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Fatal Mucormycosis and Aspergillosis in an Atypical Host: What Do We Know about Mixed Invasive Mold Infections?

“…is case report supports the hypothesis that high-dose corticosteroid administration is a risk factor for IMIs, including mucormycoses and MIMIs. Likewise, we previously reported a case of fatal mucormycosis with positive Aspergillus galactomannan at our institution after high-dose corticosteroids; however, that patient also had deep and likely prolonged neutropenia [2].…”

“…MIMIs are rarely diagnosed given lack of noninvasive diagnostic methods with adequate sensitivity; therefore, their incidence is likely underestimated. However, the associated morbidity and mortality are very high [1][2][3][4][5][6][7][8][9]. ere are very scant data regarding MIMIs, limited to a number of case reports [2][3][4][5][6][7][8] and retrospective studies in patients with hematologic malignancies [1,9].…”

“…Mixed invasive mold infections (MIMIs) are rarely diagnosed due not only to presumed low incidence but also to lack of noninvasive diagnostic methods with adequate sensitivity. Previous studies have implied that corticosteroid administration is an important, potentially underestimated risk factor for MIMI [1,2]. Herein, we present a case of fatal MIMI in a host with no "classic" risk factors for IMI, other than high-dose corticosteroids.…”