Mind the gap: Management of an emergent and threatening invasive fungal infection—a case report of rhino-orbital-cerebral and pulmonary mucormycosis

Abstract

Mucormycosis is an emergent and threatening invasive fungal invasion underdiagnosed by clinicians due to lack of awareness and aspecific clinical picture. The authors describe a clinical case of a diabetic and cirrhotic patient who developed rhino-orbital-cerebral and pulmonary mucormycosis, non-responsive to treatment. Typical gaps in the management of this deadly disease are addressed. There is a strong need for novel therapies and an expectation that sponsors will recognize the critical need for randomized clinical trials.

Epidemiology, clinical features, diagnosis and treatment of cerebral mucormycosis in diabetic patients: A systematic review of case reports and case series

“…Also, four patients treated with LAMB showed side effects: hypokalaemia with mild renal failure, minor nephrotoxicity, derangement of renal function and liver function test, and acute renal failure requiring haemodialysis after using LAMB. In all of these patients, after seeing the side effects of the drug, treatment was discontinued and alternative methods such as the use of posaconazole were adopted 16,28‐30 . Of note, in some cases, AMB and LAMB were used for a long time even in high doses for patients; no specific side effects were reported, and good therapeutic effects have been observed 31‐33 …”

“…Noteworthy, in the case of the two patients whose treatment failed after using posaconazole and died afterwards, one was subject to sepsis while posaconazole had a good inhibitory effect on CM control 17 . However, another patient died despite the use of posaconazole, which could be related to the occurrence of posaconazole‐resistant mucormycosis or under‐dosing of this antibiotic as clinicians did not perform therapeutic drug monitoring 29 . Furthermore, the results of one case series also showed that of the 12 patients who received posaconazole, eight patients (66.6%) had complete resolution (with median follow‐up of 6.5 months (range: 2‐24 months)), two patients (16.6%) had significant reduction of disease, and 2 (16.6%) had marked residual disease 34 .…”

“…In two patients, a combination of polyene and micafungin was used for a long time from 7 to 14 months and it was able to control the infection 33,35 . On the other hand, in three other patients, a combination of polyene and caspofungin was used, which had no positive effect on the infection control process 29,36,37 …”

A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis—has anything changed in the past 20 years?

“…In total, 210 case reports were identified from the literature search and reviewed, of which 175 contained sufficient clinical data to be analysed. These were derived from a total of 140 papers (some papers contained multiple case reports) . Larger case series were usually excluded due to a lack of chronological data (refer to Figure for PRISMA flow diagram).…”

Rhino-Orbito-Cerebral Mucormycosis in a Diabetic Patient with Idiopathic CD4 + Lymphocytopenia

“…In Portugal little information about this disease is available, with only three published cases in the literature [3][4][5], yet the picture is probably similar to other developed countries, where a majority of cases occur in patients with diabetes mellitus, haematological malignancies under chemotherapy and allogeneic stem cell transplant recipients [1]. It is estimated that diabetes is present in 36% -88% of cases and patients with poor glycaemic control and ketoacidosis are the ones at greater risk [1,6].…”