Angioinvasive Mucormycosis Research Articles

Angioinvasive Mucormycosis and Internal Carotid Artery Thrombosis: A Case Series

Angioinvasive Mucormycosis and Internal Carotid Artery Thrombosis: A Case Series

Angioinvasive Rhino-Orbital-Cerebral Mucormycosis in a Patient with Type 2 Diabetes Mellitus: A Complex and Lethal Cause of Stroke

Rhino-orbital-cerebral mucormycosis is a rapidly progressive and often fatal fungal infection caused by molds of the order Mucorales, particularly affecting immunocompromised individuals. This infection is notorious for its angioinvasive properties, enabling the fungi to invade blood vessels and leading to tissue necrosis. We report the clinical course of a 59-year-old Caucasian man with poorly controlled type 2 diabetes (HbA1c 16.8%) who presented with unilateral headache, left-sided facial numbness, and incomplete left ocular motor paresis. Initial presentation raised suspicion of orbital phlegmon, leading to antibiotic and later corticosteroid pulse therapy, which worsened the patient’s condition. Subsequent imaging demonstrated extensive inflammatory changes, including wall irregularities of the left intracranial internal carotid artery, accompanied by ocular protrusion and periorbital enhancement. New palatal lesions indicated mucormycosis, which was confirmed by molecular analysis of a palatal biopsy, leading to Amphotericin B treatment. Pre-surgery imaging revealed a malignant middle cerebral artery infarction, and the patient died 16 days after symptom onset and 12 days after initial presentation under palliative care due to a poor prognosis. This case of angioinvasive mucormycosis underscores the severe and often fatal course of rhino-orbital-cerebral mucormycosis in an immunocompromised individual. The rapid progression from initially vague and unspecific symptoms to extensive vascular involvement and stroke highlights the critical need for early and accurate diagnosis, as well as prompt intervention to prevent further disease progression. Additionally, this case also illustrates the potential risks associated with corticosteroid therapy in the presence of undiagnosed fungal infections, which can exacerbate the condition and lead to serious complications. Clinicians should maintain a high index of suspicion for mucormycosis in similar clinical scenarios, prioritizing adequate antifungal treatment and careful monitoring to improve patient outcomes. Early interdisciplinary collaboration is essential for the effective management of such complex cases.

Analysis of the Risk of Infection Stratified By Absolute Neutrophil Counts during Deferiprone-Associated Severe Neutropenia or Agranulocytosis

Introduction Patients with transfusional iron overload receiving iron chelation therapy with deferiprone may experience a decrease in absolute neutrophil counts (ANC) that range from mild (ANC <1.5 x 10 9/L) to severe neutropenia/agranulocytosis (typically defined as ANC <0.5 x 10 9/L), and which put them at risk for infections. In patients taking deferiprone, the risk of infection and/or mortality associated with ANC of <0.2 or <0.1 x 10 9/L is unknown. Our objective was to analyze data from patients taking deferiprone in clinical trials and the postmarketing setting to determine the incidence and severity of infection stratified by ANC levels. s Methods The clinical trial setting involved patients with systemic iron overload who had thalassemia, sickle cell disease, or other anemias and received deferiprone across 15 clinical trials. Data associated with episodes of severe neutropenia/agranulocytosis in patients who had been treated with at least 1 dose of deferiprone were reviewed. For the postmarketing setting, all individual case safety reports since the first market approval of deferiprone on August 25, 1999 to August 31, 2021, were reviewed; cases coded to agranulocytosis were extracted; cases without any reported ANC were removed; and cases with at least 1 ANC value were analyzed. Obtaining confirmed ANC value was not always possible in the postmarketing setting. All infections occuring within ±2 weeks of agranulocytosis onset were identified, graded for severity, and classified as serious, including fatal or life-threatening. Serious events were defined as any event that resulted in death, was life-threatening, required hospitalization or prolonged existing hospitalization, caused disability or permanent damage, caused congenital anomaly, or was classified as an important medical event. Infection events associated with ANC values were categorized into 3 groups based on the nadir ANC (all x 10 9/L): Group A, ANC ≥0.2 to <0.5; Group B, ANC ≥0.1 to <0.2; or Group C: ANC <0.1. Results A total of 977 patients with systemic iron overload received deferiprone in sponsored clinical trials. Among those, 9 patients were in Group A, 3 in Group B, and 10 in Group C. Of the 12 patients in Groups A and B, none had serious, severe, or fatal infections ( Table 1). Three of the 10 (30.0%) patients in Group C experienced serious or severe infections that included (1) parvovirus infection accompanied by diarrhea, a maculopaular rash, and pyrexia resulting in hospitalization; (2) a severe but nonserious respiratory tract infection with esophageal candidiasis in a patient with a history of neutropenia prior to initiating deferiprone; and (3) a fatal case of Pseudomonal sepsis in a patient who had a history of multiple cardiac and pulmonary comorbidities. Deferiprone was permanently discontinued in all 3 patients. From postmarketing data, of a total of 238 adverse reactions that were coded as agranulocytosis, 176 had at least 1 ANC value. Among those, 65 reactions were in Group A, 20 in Group B, and 91 in Group C. Among the reactions in Group A, 5/65 (7.7%) had serious infections and 3 of them (4.6%) had fatal outcomes due to sepsis ( Table 2). Among the reactions in Group B, 2/20 (10.0%) had serious infections, with a fatal outcome in one of them (5.0%); the death was from sepsis and the life-threatening infection involved pneumonia with multiple pulmonary complications. Among the reactions in Group C, 12/91 (13.2%) had serious infections and 8 of them (8.8%) had fatal outcomes; the 8 deaths were associated with sepsis. The 4 serious non-fatal infections involved sepsis; pancytopenia with ANC nadir of 0 accompanied by oropharyngeal pain, fever, and diarrhea that required hospitilization; angioinvasive mucormycosis; and disseminated herpes simplex accompanied by sepsis, resulting in hospitalization. Conclusion Patients receiving deferiprone who become neutropenic are generally at a higher risk of infections or mortality with lower neutrophil levels (ie, ANC <0.2 or <0.1 x 10 9/L compared with ANC ≥0.2 to <0.5 x 10 9/L). Our findings are consistent with the recently published guidelines from the European Hematology Association and the European Network for Innovative Diagnosis and Treatment of Chronic Neutropenias that used agranulocytosis to describe events with ANC of ≤0.2 x 10 9/L in association with a high risk of severe and life-threatening infections.

Knowledge on mucormycosis among nursing Indian students in the state of Gujarat.

The disorder known as angio-invasive mucormycosis is characterized by tissue necrosis and infarction. The Mucorales order of saprophytic fungi is responsible for its development. It is unclear how widespread mucormycosis is in India due to a lack of population-based investigations. Diabetes mellitus is the risk factor that occurs the most frequently, followed by solid organ transplant and hematological cancer. The present study has been carried out to assess the knowledge regarding mucormycosis among nursing students from Nootan College of Nursing, Visnagar, Gujarat. For this we have selected 100 students by using the probability sampling technique. Structured questions were used to assess the knowledge of nursing students regarding mucormycosis. The Score was categorized as poor, average and good. The results show that 45(45%) of the nursing students having poor knowledge, 35(35%) of them were having average knowledge, 20(20%) of them were having good knowledge. There is an association between gender, program and their level of knowledge. Most of the students having poor knowledge regarding mucormycosis and we need to create awareness regarding mucormycosis to Nursing students.

Angioinvasive mucormycosis in a patient with aplastic anemia

A 9-year-old boy with no past medical history was admitted for severe epistaxis and aplastic anemia of unknown etiology with hospital course complicated by bacteremia and the development of a tender plaque on the forearm. Exam revealed a violaceous plaque with peripheral erythema and central necrosis on the left dorsal forearm (Fig 1). Punch biopsies for frozen section and tissue cultures were obtained. Histopathologic exam showed epidermal and dermal necrosis with numerous fungal hyphae in the dermis and within small vessels (Fig 2, black arrow).

Fatal allograft mucormycosis complicating severe COVID‐19 infection and bacterial pyelonephritis

AbstractWe herein present a case of live related kidney transplant recipient who initially developed severe coronavirus (COVID‐19) disease associated with E.coli related pyelonephritis and graft dysfunction, who improved over one week only to deteriorate in the second week, with fever, oligoanuria and refractory shock. A postmortem allograft biopsy revealed angioinvasive mucormycosis. With the resurgence of mucormycosis during the COVID‐19 pandemic, the transplant team should add allograft mucormycosis as a rare differential for severe graft dysfunction and oligoanuria in the COVID‐19‐infected kidney transplant recipient.

Diabetes, COVID-19 and Mucormycosis: Unanswered Questions!

Diabetes, COVID-19 and Mucormycosis: Unanswered Questions!

Acute myocardial infarction secondary to mucormycosis after lung transplantation

We present a case of a 57-year-old man who underwent bilateral lung transplantation for idiopathic pulmonary fibrosis. His immediately post-operative course was complicated by fever and cardiac arrest. Despite supportive care and broad-spectrum antibiotics, he experienced continued clinical decline. Autopsy results indicated angioinvasive mucormycosis and coronary arteritis resulting in acute myocardial infarction as the cause of death.

Systemic mucormycosis caused by Lichtheimia ramosa in a pregnant cow

Mucormycosis is a life-threatening fungal disease caused by opportunistic pathogens present in the environment. This report presents a case of a Lichtheimia ramosa infection that manifested as characteristic lesions in various visceral organs of a pregnant cow in Korea. The post-mortem examination revealed the cause of death to be mucormycosis. The fungi isolated from the liver were found to be Lichtheimia spp. Analysis of the fungi using Internal Transcribed Spacer gene sequencing facilitated the identification of Lichtheimia ramosa. To the best of our knowledge, this is the first clinical case of angioinvasive mucormycosis in cattle.

2717 Gastric Mucormycosis and Pneumatosis in a Patient With APECED

INTRODUCTION: To describe a case of progressive, fatal gastric mucormycosis. CASE DESCRIPTION/METHODS: A 33 yo female with a history of APECED (autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy) and autoimmune hepatitis was admitted to the hospital with epigastric pain, nausea and vomiting. Medications prior to admission included levothyroxine and azathioprine. An initial CT scan of the abdomen revealed only subtle nonspecific “stranding” around the pancreas. Blood cultures were positive for E coli. Initially, the source of septicemia was unclear and the patient was treated with IV vancomycin and meropenum. A repeat CT scan 10 days later revealed gastric pneumatosis (Figure 1). EGD revealed a 3 cm ulcer in the gastric cardia (Figure 2). Biopsies of the ulcer revealed inflamed gastric mucosa with broad, sparsely-septated 10 to 20- µmfungal hyphae (with 90 degree branching) invading the mucosa, most consistent with mucormycosis. PCR of gastric biopsies were consistent with Rhizopus oryzae (a fungus in the family of Mucoraceae). A multidisciplinary decision was made to treat the patient nonoperatively with IV liposomal amphotericin, micafungin and nasojejunal feeding. She initially made slow, steady recovery but later had decompensation which led to the diagnosis of a gastro-pleural fistula. Extensive surgical debridement with resection of grossly abnormal stomach, spleen, diaphragm spleen and distal pancreas was performed. Pathology revealed extensive angioinvasive mucormycosis. She was then treated with a prolonged course of antifungals and antimicrobials (liposomal amphotericin B, posaconazole, terbinafine, meropenem, daptomycin). After a prolonged hospitalization, the patient gradually deteriorated and ultimately chose comfort measures and succumbed. DISCUSSION: Despite aggressive management with multidisciplinary expertise, widespread angioinvasive mucormycosis can be associated with a fatal outcome. Although there is no known association, the spector is raised as to whether the patient's underlying APECED was in some manner a predisposing or exacerbating factor in this patient's illness.

Mucor Thrombus

To describe a rare presentation of ischemic stroke secondary to angioinvasive mucormycosis and endovascular retrieval of mycotic thrombus with stenting of the compressed vessel. We report a case of angioinvasive mucormycosis that externally compressed and invaded the internal carotid artery causing ischemic cerebral infarction. A sample of the thrombus was obtained using a stent retriever. Subsequent pathological analysis was shown to be consistent with the diagnosis of angioinvasive mucormycosis. The thrombosed and compressed segment was recanalized with the deployment of a stent. The endovascular placement of an expandable stent in the setting of angioinvasive mucormycosis restored good cerebral blood flow in a proximal internal carotid artery occlusion. The patient's aphasia resolved following this intervention. Artifacts of CT angiography may result in the overestimation of acute arterial occlusions. Endovascular carotid stenting may be a palliative measure in the setting of angioinvasive rhino-cerebro-orbital mucormycosis.

The Case Files

The Case Files

CUTANEOUS MUCORMYCOSIS PRESENTING AS A PENILE LESION IN A PATIENT WITH ACUTE MYELOBLASTIC LEUKEMIA

Opportunistic infections are common in patients with acute hematopoietic malignancies. We report a case of mucormycosis diagnosed in a penile lesion following surgical debridement . CASE REPORT A 70-year-old white man was diagnosed with acute myeloblastic leukemia by bone marrow biopsy. He underwent chemotherapy consisting of idarubicin, cytarabine, vincristine and prednisone beginning on hospital day 3 and continuing until hospital day 13. He became neutropenic and fever developed for which he was treated with broad-spectrum antibiotics and amphotericin B. On hospital day 10 the patient noticed a blackish discoloration on the prepuce of the foreskin with encroachment onto the coronal sulcus of the glans penis. The lesion was associated with moderate edema of redundant preputial skin from an incomplete circumcision. Differential diagnosis included paraphimosis, leukemic infiltrate, opportunistic infection or cutaneous vascular lesion. After no improvement on topical antibiotics for several days revision circumcision and debridement of the lesion were planned. At surgery the lesion was found to be deeply necrotic and locally advanced, preventing a simple circumcision revision. Pathological diagnosis was angioinvasive mucormycosis (fig. 1). The patient was started on systemic liposomal amphotericin B and topical amphotericin. During the next 2 weeks circumcision healed except at the original site where an ulcer persisted. Penile magnetic resonance imaging showed only enhancement near the glans with no evidence of spread of infection (fig. 2). Further surgical debridement and cultures were performed. The area was deeply debrided with adew~~;,';~~e~~~~ :iOzp shows enhancement near glans penis quate margins. Cultures again revealed mucormycosis. Blood cultures were never positive for fungal elements. Urine and stool cultures were positive for Candida albicans and Rhizopus species.