Abstract
Disseminated mucormycosis, a serious complication, is associated with high mortality in patients with acute leukemia after chemotherapy. Blood cultures are always negative because of recurrent empirical antifungal treatments. The identification of pathogens is important for diagnosis and therapy. In this case report, we diagnosed culture-negative disseminated mucormycosis with Rhizomucor miehei infection leading to cerebral infarction in a patient with leukemia using metagenomics next-generation sequencing (mNGS) form peripheral blood, cerebral spinal fluid, and bronchoalveolar lavage fluid. mNGS technology can be applied to precisely diagnose culture-negative disseminated mucormycosis.
Highlights
Disseminated mucormycosis, characterized by necrosis and infarction of tissues due to invasion of vasculature by hyphae, is a rare disease that commonly occurs in severely immunosuppressed patients [1, 2]
We present a case of culturenegative mucormycosis with Rhizomucor miehei infection leading to cerebral infarction diagnosed by metagenomics next-generation sequencing (mNGS) of peripheral blood (PB), cerebral spinal fluid (CSF) and bronchoalveolar lavage fluid (BAL)
Hemiplegia and hemiconvulsions suddenly occurred on patient’s right limb, and computed tomography (CT) scans of patient’s brain showed a hyperdense lesion with surrounding edema, which was highly suspected as cerebral infarction in the right parietal lobe and small hypodense areas in the left and right parietal lobes
Summary
Disseminated mucormycosis, characterized by necrosis and infarction of tissues due to invasion of vasculature by hyphae, is a rare disease that commonly occurs in severely immunosuppressed patients [1, 2]. Positive culture and histological evidence for mucormycosis from blood or tissue biopsies are the key diagnostic criteria [6,7,8]. Positive blood culture results perform poorly at the onset of clinical symptoms and change of videography suspected to be mucormycosis [9,10,11,12,13]. We present a case of culturenegative mucormycosis with Rhizomucor miehei infection leading to cerebral infarction diagnosed by mNGS of peripheral blood (PB), cerebral spinal fluid (CSF) and bronchoalveolar lavage fluid (BAL). Hemiplegia and hemiconvulsions suddenly occurred on patient’s right limb, and computed tomography (CT) scans of patient’s brain showed a hyperdense lesion with surrounding edema, which was highly suspected as cerebral infarction in the right parietal lobe and small hypodense areas in the left and right parietal lobes.
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