Clinical characterization of cutaneous mucormycosis in patients receiving Bruton tyrosine kinase inhibitor therapy with Ibrutinib: A new case report and comparative discussion

Rhinocerebral mucormycosis: a potential source of false-positive uptake on [18F]FET PET/MR leading to diagnostic ambiguity.

COVID-19 associated mucormycosis and their therapeutics

Infections caused by Syncephalastrum species in humans are relatively rare. However, clinicians must maintain a high suspicion for it in immunocompromised patients with cutaneous mucormycosis. Prompt histopathological and microbiological investigations, combined with timely antifungal therapy and surgical intervention, are crucial to prevent subsequent complications and amputations.

Background:Infection with mucorales is a rare complication of uncontrolled diabetes. The infections are angio-invasive and have poor prognosis. The rhino-cerebral presentation of mucomycosis requires maxillectomies and aggressive antifungal therapy. The chances of recurrence remain high even with the best form of treatment. Honey has been used since ancient times as a dressing for wounds. It is said to aid wound healing by promoting the formation of granulation tissue. This property may be useful in cases where maxillectomy defects cannot be skin grafted.Patients and Methods:A review of literature on rhino-cerebral mucormycosis and the angiogenetic, antiseptic/healing characteristics of honey was carried out with the aim of highlighting its benefits in the intraoral perioperative management of craniomaxillofacial/rhino-cerebral mucormycosis. An illustrative case is presented to showcase these properties in the management of a 47-year-old diabetic male patient who presented with palatal mucormycosis, with treatment involving the therapeutic, surgical, and the reconstructive aspects of care.Results:Following intensive systemic antifungal use and surgical debridement, the patient developed extensive necrosis of the residual palatal defect which was refractory to eradication. The introduction of a pack impregnated with honey into the defect produced significant improvement in intraoral wound healing. This was accompanied by a rapid granulation of the defect resulting in a clean site.Conclusion:Topical honey dressings are recommended as an effective adjunct to conventional therapies for managing post-rhino-cerebral mucormycotic maxillectomy defects.

A 43-year-old man with myelodysplastic syndrome underwent umbilical cord blood transplantation (CBT). On day 4 post-transplantation, he developed right periorbital pain and oculomotor nerve palsy. Brain MRI revealed fluid accumulation in the sphenoid sinus and mucosal thickening in the right maxillary sinus. Given the extraordinarily early onset and neurological involvement, fungal meningitis, including mucormycosis, was suspected, and empirical high-dose liposomal amphotericin B (10mg/kg/day) was initiated. Nasal discharge culture yielded Rhizomucor species, later identified as Rhizomucor miehei by polymerase chain reaction (PCR). Despite aggressive antifungal therapy, the patient's neurological condition deteriorated, and he died on day 49. Autopsy confirmed extensive rhino-cerebral mucormycosis with angioinvasion, and Mucorales DNA was detected in brain tissue by quantitative PCR. To our knowledge, this represents the first reported case of R. miehei infection occurring within days after transplantation, preceding neutrophil engraftment. This case highlights the importance of recognizing mucormycosis even in the immediate post-transplant period and underscores the limitations of antifungal therapy in the absence of surgical debridement.

Introduction: Mucormycosis is a severe infection that mainly develops in immunocompromised patients. During the COVID- 19 pandemic, there was an increase in the incidence of mucormycosis, high prevalence was observed in many countries of the world, for example, in India. The number of publications on mucormycosis in electronic libraries has increased more than 1.5 times over the past four years. Patients with COVID-associated mucormycosis (COVID-M) predominantly develop lesions of the paranasal sinuses — up to 96%. Mucormycosis of the paranasal sinuses is characterized by high disability and mortality of up to 80%. Objective : To analyze the results of multispiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in patients with COVID-associated rhinocerebral mucormycosis to improve the effectiveness of disease diagnosis. Materials and methods: The registry of patients with mucormycosis included 100 patients with COVID-associated paranasal sinus mucormycosis. The criteria of EORTC/MSG, 2020 were used to make the diagnosis of «invasive mycosis». Retrospectively, using the Weasis v4.5.0 program, the multispiral computed tomography data of 41 patients were analyzed in dynamics. The median age of the patients was 61 years (22–83), 56% of them men. CT-studies were performed using a GE Bright Speed 16 tomograph, GE Revolution HD, Philips Ingenuity Core 64, Aquilion PRIME 1. Statistics: Statistical data analysis was performed using the Microsoft Office Excel 2019. Survival analysis was performed using the Kaplan-Mayer method. Results: The main clinical symptoms were swelling of the soft tissues of the face and eyes (93%), local pain syndrome (88%), facial numbness (78%), paresthesia (76%), visual impairment (66%). Thickening of the mucous membranes (100%) was observed in the nasal cavity with the formation of necrotic masses and a characteristic «black scab» (90%). The main radiological signs were: hypertrophy of the mucous membranes of the paranasal sinus — 100%, destructive changes in the walls of the sinuses and bones of the skull — 100%; edema, thickening of the soft tissues of the face, orbit and brain — 93%. Destructive changes of the maxillary sinuses were detected in 100% of patients, the walls of the orbits — 95%, the latticed bone — 93%, the maxilla — 85%, the walls of the main sinus and the sphenoid bone — 83%, the frontal sinuses — 37%. The lesion of the optic nerve is in 66%. According to the central nervous system, damage to the frontal lobe was detected in 32% of cases, damage to the temporal lobe — 15%. Cavernous sinus thrombosis — 46%. In case of orbital damage, CT-signs were determined on day 12 (median 12.5±4.9 days) from the onset of clinical manifestations, involvement of the optic nerve in the infectious process also on day 12 (median 12±4.1 days). CT-changes from the central nervous system were observed on day 18 (median 18±10.45 days). The survival rate of patients within 3 months was 88%, and within 1 year — 78%. Discussion : The main underlying diseases in mucormycosis today are COVID-19 (46%) and oncohematological pathology (37%). When analyzing the risk factors for the development of rhinocerebral mucormycosis, the main importance is the presence of concomitant diabetes mellitus (88%), as well as long-term use of glucocorticosteroids (GCS) in high doses (90%). The main CT-signs of rhinocerebral mucormycosis were the destruction of the walls of the paranasal sinuses and cranial bones, which occurs on days 7–12 from the onset of the first clinical symptoms. Conclusion: Radiation examinations are the leading imaging methods for rhinocerebral mucormycosis. The examination protocol must include a MSCT scan of the paranasal sinuses and an MRI scan of the brain. Early radiological diagnostics reduces mortality and disability of patients.

Mucormycosis is an angioinvasive, rapidly progressive, and often fatal infection caused by a group of filamentous molds within the Class Zygomycetes. Even a slight delay in initiating treatment can significantly worsen the prognosis. Cutaneous mucormycosis, the third most common form of this infection, typically occurs in immunocompetent individuals following trauma or wounds. This report details the case of a 48-year-old Han Chinese female farmer with type 1 diabetes, who was diagnosed with primary cutaneous mucormycosis caused by Mucor irregularis (M. irregularis) and showed significant improvement following antifungal treatment.

Background & Objectives: Mucormycosis is a fungal infection which mainly affects immunocompromised patients and the cases showed an upward trend coinciding with the second wave of COVID-19 pandemic in India. Considering the poor prognosis of established mucormycosis cases, it is worthwhile to identify them at earliest within COVID-19 patients. The objective of this study was to monitor COVID-19 patients prospectively for mucor spp.. and other fungal infections via detailed microbiological analysis of their nasal wash samples. Materials and Methods: COVID-19 patients were called upon at every week interval for one month after their COVID-19 infection and their nasal wash samples were subjected to KOH mount, Gram staining, Calcofluor white staining, SDA culture and LPCB mount. Results: A total of 297 samples were derived from 90 patients. 16(5.3%) were positive for fungal elements in KOH and calcofluor staining. Culture of samples on SDA agar showed that 13(4.3%) samples had Mucor spp. All 13 patients were hyperglycemic during their course of COVID-19. Conclusions: Around 4.3% nasal wash samples of COVID-19 immunocompromised patients taken within two weeks of COVID-19 infection demonstrated definite growth for mucor spp.. These patients could be closely monitored for mucormycosis symptoms/complications and timely interventions could be provided therein. DOI: https://doi.org/10.52783/jchr.v16.i1.11471

Rhino-cerebral mucormycosis is a rare and rapidly progressing angio-invasive infection affecting immunocompromised individuals, with an extensive surgical resection of the affected bone resulting in a huge defect. Rehabilitation of such surgical defects requires bone augmentation and extended rehabilitation time, with donor site morbidity and inconsistent graft resorption rates. Patient-specific eposteal implants (PSEI) are an alternative approach that can circumvent the shortcomings mentioned above with accuracy and reduced operating time. Quad-zygoma implantssupported prosthesis and removable obturators with cast-partial framework are the other rehabilitation methods in the literature. PSEIs shall be the choice where inadequate zygomatic bone restricts the endosteal zygomatic implant placements. The presented patient suffered from speech disarticulation, dysphagia, food and fluid reflux, and hypernasal twang. The present case report describes the prosthetic rehabilitation of a post-rhino-cerebral mucormycotic surgical defect with a PSEI-supported removable hollow bulb obturator with a 12-month post-prosthetic follow-up. Bangladesh Journal of Medical Science Vol. 25. Supplementary Issue 2026, Page : S184-S187

Rhino-orbital mucormycosis is an aggressive, angioinvasive fungal infection predominantly affecting immunocompromised individuals, especially those with uncontrolled diabetes mellitus and recent corticosteroid use. Secondary cutaneous facial involvement is rare and indicates advanced disease with increased morbidity and mortality. We report a rare case of rhino-orbital mucormycosis in a 54-year-old diabetic male with a recent history of COVID-19 associated steroid therapy. The patient presented to the ENT outpatient department with unilateral facial pain, nasal obstruction, and blood-tinged nasal discharge. Endoscopic examination revealed necrotic nasal mucosa, and microbiological evaluation confirmed mucormycosis. Despite early diagnosis and initiation of antifungal therapy, the patient developed rapidly progressive secondary cutaneous facial necrosis over the left malar region. Histopathology of skin biopsy demonstrated angioinvasive, aseptate fungal hyphae, confirming secondary cutaneous mucormycosis. Management involved aggressive multidisciplinary care with intravenous liposomal amphotericin B, strict glycaemic control, repeated endoscopic sinus debridement, and surgical excision of necrotic facial skin. Secondary cutaneous facial necrosis in rhino-orbital mucormycosis represents severe disease progression. Early recognition, prompt antifungal therapy, radical surgical debridement, and close ENT?Dermatology collaboration are crucial to improving survival and clinical outcomes.

Mucormycosis is a rare, aggressive fungal infection primarily affecting immunocompromised individuals. It can lead to significant tissue necrosis, including maxillary destruction. This case report explores the prosthetic rehabilitation of a patient with a severe maxillary defect caused by rhinocerebral mucormycosis, focusing on the challenges and effectiveness of reconstructive interventions. A 68-year-old male with a history of recent COVID-19 infection presented with facial pain, swelling, and blurred vision. Diagnosis of rhinocerebral mucormycosis was confirmed, and the patient underwent urgent surgical debridement, including left hemimaxillectomy and enucleation of the left eye. A maxillary obturator was fabricated to restore oral and nasal cavity separation, enhancing speech and swallowing. An orbital prosthesis was integrated using magnetic attachments for enhanced retention. The patient successfully adapted to the prostheses, regaining essential functions. At the 2-year follow-up, he reported significant improvements in both function and esthetics, with the magnetic attachments ensuring comfort and ease of use.

Evaluating the combined impact of amphotericin B and posaconazole on the germination of a rare Rhizopus homothallicus isolate responsible for COVID-19 associated mucormycosis.

Background: Mucormycosis is a rare fungal infection caused by a group of opportunistic fungi from the class Zygomycetes. Primary cutaneous mucormycosis is the most common type of mucormycosis in immunocompetent patients. This study reported a case of primary cutaneous mucormycosis with nonspecific clinical characteristics and various supporting examinations. The patient was successfully treated with in toto excision and oral ketoconazole. Case Illustration: A 40-year-old female presented with purplish-red spots and painless lumps on the second finger of her right hand, which had been present for a year. She had a history of frequent fish tank cleaning and gardening but denied any known injury. Physical examination revealed multiple well-circumscribed and confluent erythematous-violaceous plaques and nodules. An in toto excisional biopsy was performed for histopathological examination, culture, and a rapid molecular test (RMT) using the Xpert MTB/RIF® test (Cepheid, USA). Histopathological examination revealed granulomatous suppurative inflammation, and fungal culture revealed growth of Mucor species. Discussion: Clinical findings in cutaneous mucormycosis are nonspecific. The diagnosis is confirmed by identifying the organism through biopsy and histopathological examination, as well as culture. Histopathology will reveal granulomas in the dermis and subcutis containing numerous macrophages and Langhans giant cells, often with phagocytosed fungal elements. Fungal culture yields positive results in 72–89% of cases of skin mucormycosis conducted on Sabouraud and potato dextrose agar media. Conclusion: This case emphasizes the need for broad differential consideration and thorough diagnostic workup in nonspecific cutaneous mucormycosis and supports surgical excision with systemic antifungal therapy for chronic, localized primary disease.

Abstract Continuous intraoperative hemodynamic monitoring is essential during endovascular procedures. Ethylene vinyl alcohol (EVOH) embolization, using Onyx liquid embolizing agent with dimethyl sulfoxide, can trigger an unusual brainstem reflex termed the “trigeminocardiac reflex (TCR),” characterized by sudden bradycardia and hypotension. We report a case of intracranial mycotic pseudoaneurysm in a postoperative case of coronavirus disease 2019-associated rhinocerebral mucormycosis patient, treated with parent artery occlusion using Onyx and coils. Intraoperatively, TCR was promptly recognized and managed, ensuring hemodynamic recovery and favorable outcome. This case highlights the importance of early TCR detection and management during EVOH embolization for optimal patient care.

No abstract available

Rhinocerebral mucormycosis is an invasive fungal infection of the paranasal sinuses, orbits, and cranium, caused by saprophytic fungi of the order Mucorales. This infection spreads locally and rapidly in susceptible individuals due to the angio-invasive nature of the fungi. Infection spreading into the base of the skull can cause lesions of the jugular foramen and hypoglossal canal, leading to Collet-Sicard syndrome.We report a 57-year-old woman who presented with fever, headache, vomiting for four days and acute loss of vision in the right eye on a background of long-standing diabetes. She had chemosis and proptosis of the right eye with blindness and complete ophthalmoplegia. There was facial sensory loss in the distribution of the ophthalmic and maxillary divisions of the trigeminal nerve. Non-contrast computerised tomography scan of the head showed right maxillary, sphenoid, and ethmoid sinus inflammation, with cavities filled with heterogeneous material. Subsequently, she developed right lower four cranial nerve palsies suggestive of Collet-Sicard syndrome. To our knowledge, this is the first reported case of Collet-Sicard syndrome due to mucormycosis in the global literature.

ZCutaneous mucormycosis is a rare, invasive fungal infection with high morbidity and mortality, particularly in immunocompromised individuals.This report presents the case of a 30-year-old male with acute myeloid leukemia who developed cutaneous mucormycosis, manifesting as necrotic nodules on the arms and a hemorrhagic papule on the tongue.Despite negative fungal culture results, histopathological examination revealed broad, non-septated hyphae, confirming the diagnosis.The patient was treated with intravenous amphotericin B. This case underscores the critical need for early clinical suspicion, prompt histopathological evaluation, and timely initiation of empirical antifungal therapy to improve patient outcomes in high-risk populations.

Mucormycosis (MCM) is an opportunistic fungal infection in immunocompromised hosts, most commonly associated with poorly controlled diabetes mellitus (DM). We conducted a retrospective review of 45 MCM cases diagnosed between 2010 and 2023 at a referral center in Central California, a region with high DM prevalence and significant healthcare disparities. Clinical features, histopathology, microbiology, treatment, and outcomes were analyzed. Ninety-six percent of patients had DM, and 69% had no other predisposing condition. Glycemic control was markedly poor: 36% had HbA1c > 10%, and 61% had HbA1c > 8%. Diabetic ketoacidosis (DKA) was present in 19% of patients and associated with 100% mortality. Rhino-orbito-cerebral mucormycosis (ROCM) accounted for 60% of cases and carried a 70% mortality rate. Angioinvasion, confirmed in 62% of biopsied cases, significantly increased mortality (69% vs. 28%, p = 0.015). In-hospital mortality remained high at 58%, consistent with outcomes reported in other high-burden settings. Over 60% of patients identified as Hispanic. ZIP code–based analyses revealed that 75% of individuals lived in neighborhoods with Healthy Places Index (HPI) scores below the 25th percentile, and 64% resided in areas with a Social Deprivation Index (SDI) of 85 or higher, indicating entrenched structural disadvantage. Our findings highlight that MCM in Central California disproportionately affects individuals with uncontrolled DM living in socially deprived areas. These data underscore the need for early diagnosis, targeted antifungal therapy, and upstream public health interventions addressing diabetes management and healthcare access.

Patient: Male, 40-year-oldFinal Diagnosis: Cutaneous mucormycosisSymptoms: Post bomb blast injury • generalized unspecific symptoms of chills, rigors and sweating, in precensce of worsing wound conditionsClinical Procedure: —Specialty: Infectious Diseases • SurgeryObjective: Rare diseaseBackgroundMucormycosis is known for being an aggressive fungal infection that is associated with high morbidity and mortality. Due to its nonspecific presentation, diagnosis is challenging, and a high level of suspicion is required to optimize patient outcomes. This report discusses a case of mucormycosis infection in a bomb blast victim who was identified early, treated promptly, and was eventually discharged 1 month after admission.Case ReportWe report the case of a 40-year-old male patient who sustained a bomb blast injury. He arrived at a tertiary hospital 3 days after the injury, in pain and tachycardic, with multiple wounds and shrapnel covered in soil. During hospitalization, he developed generalized symptoms, and his wounds were not improving, having more discharge and necrosis, despite receiving appropriate empirical antibiotics. Empirical anti-fungal therapy was started due to suspicion of mucormycosis, which was later confirmed histopathologically. The patient has completed 32 days of anti-fungal therapy, 11 intraoperative sessions of surgical debridement, and a change of dressing utilizing our personally developed protocol. He was discharged 44 days after admission, living independently with an excellent quality of life.ConclusionsMucormycosis is a rare yet fatal infection. A definitive diagnosis is established based on histopathological evidence or positive culture of the suspected debrided tissue. The cornerstone of treatment for mucormycosis is the early initiation of amphotericin B deoxycholate and frequent, aggressive debridement of infected tissue.