Widely Disseminated Cunninghamella Mucormycosis in an Adult Renal Transplant Patient: Case Report and Review of the Literature

Abstract

A case of widely disseminated mucormycosis involving Cunninghamella bertholletiae is reported. This represents the first report of Cunninghamella infection in a transplant patient and, to our knowledge, only the eighth reported case of human infection by this saprophytic fungus. The clinical course was similar to most of the previously reported cases in that the patient was immunocompromised prior to the infection and the diagnosis was made too late for appropriate therapeutic intervention. The current case is unique in that it involved a renal allograft recipient; that the major clinical signs and symptoms mimicked myocardial infarction; and that there was more widespread dissemination than in earlier cases. The histologic and laboratory identification of the fungus are presented and correlated with the clinical parameters (signs, symptoms, and therapy) of this case as well as the cases previously reported in the literature.

Disseminated Cunninghamella bertholletiae infection with spinal epidural abscess in a kidney transplant patient: case report and literature review

“…C. bertholletiae infection is a rare cause of invasive mucormycosis and has a strong predilection to affect immunocompromised patients. Previously reported cases were described and >98% of patients had immunodeficiency states: leukemia , solid organ transplantation , bone marrow transplantation , diabetes mellitus , non‐malignant hematologic disease , deferoxamine‐based therapy , AIDS , cirrhosis , and immunosuppressive therapy. Only 2 cases were reported in immunocompetent patients .…”

Infections due to emerging and uncommon medically important fungal pathogens

“…Characterised by broad, sparsely septated, and irregularly branched hyphae in tissue, they appear in culture as a rapidly growing mould that forms a variety of structures including stolons, rhizoids, sporangia, apophyses, sporangiophores, sporangia, collumellae and sporangiospores. Rhizopus is the most common genus to cause infection [110,111], however a number of other Zygomycetes have been increasingly reported as causing devastating infections in immunocompromised patients [110][111][112][113][114][115][116][117][118][119][120][121], While a detailed discussion of the class Zygomycetes is beyond the scope of this paper, we will review some of the salient features of these organisms as they infect immunocompromised hosts.…”

Uncommon opportunistic fungi: new nosocomial threats

“…is the most commonly implicated organism [126], an expanding spectrum of other Zygomycetes has been reported during the past decade, including but not limited to Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Cokeromyces [126,. Cunninghamella bertholletiae is associated with locahzed or msseminated infection in immunocompromised patients or those receiving desfenioxamine therapy [131][132][133]1361 and may be the cause of breakthrough fungal infections in neutropenic patients receiving itraconazole prophylaxis [138]. In contrast to R. oyzue, seldom does C. bertholletiue cause rhinocerebral zygomycosis in patients with diabetic ketoacidosis.…”