<i>Apophysomyces elegans</i> - renal mucormycosis in a healthy host: A case report from south India

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

“…The route of infection in renal tissue is not known, but ureter involvement was reported for two of these patients (204,327), whereas contiguous spread from the abdomen was suspected in another case (55). These patients underwent successful treatment with AmB alone (204), nephrectomy (327), and/or drainage of the renal abscess guided by ultrasound (55).…”

“…The fungal inoculation source and predisposing condition for Apophysomyces elegans are occasionally unknown (Table 2) (55,56,144,184,327). Among cases with unknown or undescribed (n ϭ 12) or no (n ϭ 12) predisposing factors (Table 2), and excluding cases with underlying conditions (n ϭ 5) (55, 56, 117a, 246, 307), 8 (40%) were rhino-orbital infections where the acquisition was likely related to spore inhalation (55,304,318,322).…”

“…Among cases with unknown or undescribed (n ϭ 12) or no (n ϭ 12) predisposing factors (Table 2), and excluding cases with underlying conditions (n ϭ 5) (55, 56, 117a, 246, 307), 8 (40%) were rhino-orbital infections where the acquisition was likely related to spore inhalation (55,304,318,322). Therefore, in 11 (15%) previously healthy patients who developed soft tissue infection (n ϭ 5) (55,144,246), osteomyelitis and arthritis (n ϭ 1) (212), or kidney (n ϭ 4) (55,184,204,327) or intra-abdominal infection with kidney involvement (n ϭ 1) (55) caused by Apophysomyces elegans, no predisposing factor was detected. Apophysomyces elegans is believed to be incapable of penetrating intact skin (64), but trauma without visible breakage of skin integrity was deemed responsible for Apophysomyces elegans osteomyelitis of the sternum that appeared clinically 2 months later in a previously healthy individual (88).…”

“…Isolated renal mucormycosis caused by Mucormycetes has rarely been reported (54,287). Isolated renal Apophysomyces elegans infections without any apparent predisposing factors were reported for three previously healthy individuals (55,204,327) and one patient with chronic alcoholism (55). The route of infection in renal tissue is not known, but ureter involvement was reported for two of these patients (204,327), whereas contiguous spread from the abdomen was suspected in another case (55).…”

“…Isolated renal Apophysomyces elegans infections without any apparent predisposing factors were reported for three previously healthy individuals (55,204,327) and one patient with chronic alcoholism (55). The route of infection in renal tissue is not known, but ureter involvement was reported for two of these patients (204,327), whereas contiguous spread from the abdomen was suspected in another case (55). These patients underwent successful treatment with AmB alone (204), nephrectomy (327), and/or drainage of the renal abscess guided by ultrasound (55).…”