Disseminated mucormycosis

Excerpt

During the treatment of an acute myeloid leukemia, a 49-year-old woman developed a fever and was admitted to the ICU because of septic shock and respiratory failure. Broad spectrum antibiotics were started and computed tomography showed pulmonary ground-glass opacity in the right upper lobe (Fig. 1a), multiple hypodense hepatic nodules (Fig. 1b), and hypodense lesions of the spleen and the right kidney. A first transesophageal echocardiography (TEE) did not find endocarditis. High-dose liposomal amphotericin B was added, and the larger liver nodule was biopsied. Microscopic histological examination showed many fungal spores and filaments with right-angled connexion, suggesting Mucorales, within hepatic necrosis (Fig. 2a) and vascular lumen (Fig. 2b). Serum mucorales qPCR was strongly positive for Rhizomucor and intravenous isavuconazole was added. A cerebral MRI showed multiple ischemic lesions (Fig. 1c) suggesting fungal invasion of brain arteries and/or fungal emboli. Further TEE highlighted the occurrence of vegetation in the mitral valve (Fig. 1d) compatible with mucormycosis endocarditis. Despite aggressive therapy, her condition evolved towards death.

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