Published in:
01-05-2019 | Imaging in Intensive Care Medicine
Autopsy-confirmed fulminant mucormycosis: a skin lesion revealing multiple organ dissemination
Published in: Intensive Care Medicine | Issue 5/2019
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A 54-year-old man was admitted to the intensive care unit (ICU) with a coma requiring mechanical ventilation (day 1). The Glasgow coma score was 3 and there was no meningeal syndrome. A single inflammatory and necrotic skin lesion on the right thigh was noticed (Fig. 1a). Twelve days earlier, the patient had received autologous haematopoietic stem cell transplantation following immunochemotherapy for a cerebral relapse of primary central nervous system lymphoma. Broad-spectrum antibacterial treatments and caspofungin followed by voriconazole were given during neutropenic fever.
Fig. 1
Clinical and radiological findings with pathology confirmation of disseminated mucormycosis. a A well-limited necrotic skin lesion with surrounding erythematous halo on the right thigh first revealed mucormycosis. Pathology confirmed an angio-invasive process, showing mycotic material occluding the lumen of a dermal arteriole. b Brain magnetic resonance imaging with contrast-enhanced T1-weighted sequence found a hypointense lesion involving both grey and white matter in the right parietal lobe. Gross pathology found the same parietal lesion and others in the left and right basal ganglia (arrows), all confirmed to be ischaemic infarctions. c Abdominal axial section of contrast-enhanced computed tomography (CT) scan found hypodense lesions in the liver segments IVa and VII that were found to be necrotic subcapsular nodules on gross pathology. d Both CT scan and autopsy also found extensive infarction involving the spleen. e The right kidney was also severely damaged as shown on a coronal section of an abdominal CT scan; three lesions were found on gross pathology (arrows)
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