To the Editors: In the review article on zygomycosis in children by Zaoutis et al1 it is clearly outlined that this rare but life-threatening infection does occur in individuals with predisposing factors, such as neutropenia in hematopoietic stem cell transplant recipients and patients with hematological malignancies, diabetes mellitus, burns, surgery and trauma, desferoxamine therapy, as well as certain “pediatric-specific” conditions such as high-risk premature newborns, juvenile-onset (type 1) diabetes mellitus with uncontrolled diabetic ketoacidosis, and congenital metabolic aciduria. We have recently been surprised by finding widespread Absidia corymbifera infection on postmortem of a 14-year-old boy who presented 1 month before he died with signs and symptoms of acute community-acquired pneumonia. With worsening respiratory function despite broad-spectrum antibiotics, and with no diagnosis established of the underlying disease despite extensive investigations before developing adult respiratory distress syndrome requiring mechanical ventilation and treatment with high-dose steroids, he was referred for emergency support with extracorporeal mechanical oxygenation (ECMO). Open lung biopsy at that stage revealed Aspergillus fumigatus invasive pneumonia and the dihydrorhodamine neutrophil oxidative burst flowcytometry assay was diagnostic for chronic granulomatous disease (CGD), subsequently confirmed to be a result of p47phox mutation. The past medical history was uneventful except that he helped cleaning gutters of dead leaves the week before he presented. Despite combined antifungal (voriconazole and caspofungin) therapy, γ-interferon, and granulocyte transfusions, he died of multiorgan system failure. This case was reported recently as patient 1 of the series of 9 patients describing the newly recognized emergency presentation of CGD, the “fulminant mulch pneumonitis.”2 Other patients in that series, all exposed to recent inhalation of mulch, had multiple fungal infections besides Aspergillus spp., mainly with Rhizopus spp., another of the Zygomycetes class, and Penicillium spp. However, we could not find any previous reports of A. corymbifera infection in CGD, neither is that mentioned in the recent extensive review on fungal infections in primary immunodeficiency.3 Mario Abinun, MD Department of Paediatric Immunology Chris Wright, FRCPath Department of Histopathology Kate Gould, FRCPath Department of Microbiology Terence J. Flood, MA, MRCPI Department of Paediatric Immunology Jane Cassidy, MRCP Department of Paediatric Intensive Care Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom