Mucormycosis in Mato Grosso, Brazil: A Case Reports, Caused by Rhizopus microsporus var. oligosporus and Rhizopus microsporus var. rhizopodiformis

Abstract

We identified the etiological agents responsible for two fatal cases of rhinocerebral mucormycosis with the classical risk factor for uncontrolled type II diabetes mellitus. Their initial symptoms did not point immediately to the suspicion of mucormycosis. Case 1, caused by Rhizopus microsporus var. oligosporus, was a 52-year-old man who presented with a painful pimple on his nose, which evolved with swelling, erythema, and a central pustule on his right hemiface suspected to be cellulitis. After 7 days of antibiotic treatment, the patient worsened with signs of sepsis and the lesion evolved to necrosis involving all his right face. Case 2, caused by Rhizopus microsporus var. rhizopodiformis, was a 57-year-old woman placed on continuous therapy with azathioprine and corticoids after a renal transplant due to chronic arterial hypertension and uncontrolled type II diabetes mellitus. Because she was suspected to have sepsis, the patient was treated with broad-spectrum antibiotics and mechanical ventilation, yet she deteriorated. Because Candida spp. were isolated from urine and a BAL, she was treated with fluconazole for 10 days, then substituted by caspofungin. Two weeks later, she presented with exophthalmus of the left eye that was surrounded by a large inflammatory and necrotic area. Both patients were the diagnosed with mucormycosis via direct microscopy of necrotic material prior to their death.

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).…”

Fatal rhinocerebral mucormycosis in a patient with ulcerative colitis receiving azathioprine and corticosteroid

“…Therefore, azathioprine is associated with an increased risk of developing some opportunistic infections, including those caused by cytomegalovirus and varicella-zoster virus, as well as invasive mucormycosis [18-20]. In our case, the long-term usage of azathioprine for the treatment of ulcerative colitis may have predisposed the patient to fulminant rhinocerebral mucormycosis.…”

Multiple Skin Abscesses Caused by <i>Rhizopus</i> sp. Infection after <i>Candida albicans</i> Infection in an Immunocompromised Patient

“…In contrast, primary candidiasis causes isolated nodules or abscesses 3) . Approximately 19% of patients with mucormycosis develop this condition in the skin, and 39% of patients with sinus mucormycosis show rapid development of facial skin necrosis 5,6) . The lesions may progress rapidly into reddish purple, indurated plaques, followed by necrosis and eschar formation with pain due to angioinvasion by the organisms 7,8) .…”