Fulminant myocarditis and pulmonary cavity lesion induced by disseminated mucormycosis in a chronic hemodialysis patient: Report of an autopsied case

Abstract

Mucormycosis is a rare fungal infection occurring in the immunocompromised host. It is difficult to diagnose, and its cardiac involvement is extremely rare. Here, we report a 64‐year‐old Japanese man with a 5‐year history of hemodialysis with disseminated mucormycosis causing fulminant myocarditis and pulmonary necrosis under glucocorticoid use. Two months before, he had received an implantable cardioverter defibrillator and started to take amiodarone for recurrent ventricular arrhythmias due to hypertensive cardiomyopathy. He developed amiodarone‐induced interstitial pneumonia and then received glucocorticoid therapy. Although the interstitial pneumonia partially improved, a lung cavitary lesion developed in the upper right lobe. Antibiotics had no effect, and serologic tests, blood and sputum cultures and bronchoalveolar lavage fluid were all negative for infectious pathogens. Eventually, he died of fulminant myocarditis. Autopsy revealed disseminated mucormycosis with vascular invasion and fungal thrombi, hemorrhage and infarction in lung (cavity lesion), heart (severe myocarditis), brain, thyroid and subcutaneous tissue around the implantable cardioverter defibrillator. The lung cavitary lesion was the only clinical finding suggestive of mucormycosis before autopsy. When an immunocompromised patient shows a progressive lung cavity lesion, the possibility of mucormycosis should be considered so that a broad‐spectrum antifungal agent can be empirically administered in a timely fashion.

Detection of Fungal Infection in Patients on Hemodialysis with Double Lumen Catheter by Conventional and Molecular Methods

“…using the BacT ALERT for blood culturing (17) . Another study done by Fujisawa et al in (2020) showed that hemodialysis patients are at high risk for mucormycosis due to long term of hemodialysis treatment and the use of certain medications specially in elderly (18) .…”

Risks of mucormycosis in the current Covid-19 pandemic: a clinical challenge in both immunocompromised and immunocompetent patients

“…Thus, as a precautionary measure, serial echocardiographic assessment and cardiac MRI scan is advised to post covid-19 patients after 6 weeks of presentation who had fibrosis and inflammation during the acute phase of covid [ 27 ]. Several other studies showed the possibility of Mucormycosis and Amphotericin B (causing several electrolyte imbalances) that could be the leading cause for progressive cardiac dysfunction and severe myocarditis leading to death [ 28 , 29 ].…”