1/700. Two cases of disseminated mucormycosis in patients with hematological malignancies and literature review. Two cases of disseminated mucormycosis in patients with underlying hematological disease are described. Both patients presented with fever and pulmonary infiltrates which did not respond to empirical treatment with broad-spectrum antibiotics and antifungal agents, and in both patients there was rapid progression with a fatal outcome. All cultures were negative and the diagnosis was made postmortem. A review of the literature revealed only three recent reports of successful treatment of disseminated mucormycosis. Survival correlated with control of the underlying disease and early diagnosis based on histological examination of biopsy specimens from suspected lesions. Therapy consisted of surgical debridement and amphotericin b. Standard therapeutic schedules need to be defined for this infection. ( info) |
2/700. Primary subcutaneous mucormycosis (zygomycosis): a case report. A case of mycormycosis presenting primarily as a subcutaneous mass of the left leg in an immunocompetent individual is described. The mass that was diagnosed initially as a non-specific foreign body granulomatous process recurred a year later. Histopathological examination of the primary and recurrent lesions revealed partly degenerated hyphae associated with acute necrotizing and chronic granulomatous inflammation. Histomorphological features of primary subcutaneous mucormycosis without predisposing factors have not been previously reported. ( info) |
3/700. Endoscopic sinus surgery in the management of mucormycosis. This is a report of the use of endoscopic sinus surgery in the management of three patients diagnosed with rhino-orbital or rhino-orbito-cerebral mucormycosis. A retrospective review was performed of the clinical examinations and imaging studies of three patients who underwent endoscopic sinus surgery as part of their therapy for mucormycosis. In addition to endoscopic surgery, all patients had aggressive control of underlying risk factors (diabetes mellitus, immunosuppression) and prolonged intravenous amphotericin b therapy. All three patients survived and avoided orbital exenteration. In selected patients with rhino-orbito-cerebral mucormycosis, endoscopic techniques can play a valuable role in diagnosis and management. ( info) |
4/700. Isolated pontine infarction due to rhinocerebral mucormycosis. We report a patient with rhinocerebral mucormycosis whose initial central nervous system involvement was isolated pontine infarction due to basilar arteritis caused by the fungus. The patient was diagnosed and followed by MRI and CT and basilar arteritis was demonstrated well on MRI studies. Involvement of the skull base was shown on CT in the later stage of the disease. The unusual initial presentation of the infection is discussed. ( info) |
| The patient, a 59-year-old male, had been diagnosed as having alcoholic hepatopathy 20 years previously. He noticed localized swelling on his left leg after fishing in a river. The patient was diagnosed as having cutaneous mucormycosis upon histological and mycological examination of the skin. Gradual improvement of the symptoms was noted four weeks after administration of itraconazole and fruconazole; these were discontinued after five months. ( info) |
6/700. zygomycosis due to Apophysomyces elegans: report of 2 cases and review of the literature. OBJECTIVE: The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen. methods: Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A. elegans that have been reported in the literature were reviewed. RESULTS: Both patients developed infection due to A. elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A. elegans, was isolated from each case. CONCLUSION: Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin b. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy. ( info) |
7/700. Lung cancer, proptosis, and decreased vision. A 48-year-old man presented to the emergency department with a 3-day history of decreased vision in a painful proptotic right eye. The patient was being treated with chemotherapy and radiation for non-small cell lung carcinoma. Examination showed visual acuity of hand motions, decreased motility, and an afferent pupillary defect on the right, consistent with an orbital apex syndrome. neuroimaging revealed "dirty" orbital fat and no paranasal sinus disease. Orbital biopsy initially showed only fibrosis; however, on subsequent biopsies, nonseptate hyphae later identified as mucormycosis was recovered. The patient survived with exenteration and systemic amphotericin b. ( info) |
8/700. Pulmonary rhizopus rhizopodiformis cavitary abscess in a cardiac allograft recipient. Pulmonary mucormycosis is rare in solid organ transplant recipients. Only one case has been reported previously in a cardiac allograft recipient. However, the rhizopus species in that study was not identified. We report a case of successful surgical treatment of pulmonary cavitary mucormycosis due to rhizopus rhizopodiformis in a cardiac allograft transplant recipient. A review of the literature on pulmonary mucormycosis occurring in solid organ transplant recipients is also presented. ( info) |
9/700. Pulmonary mucormycosis: the last 30 years. Pulmonary mucormycosis is relatively uncommon but an important opportunistic fungal infection in immunocompromised persons. The literature on the subject is sparse. We describe a recent case and review the literature to delineate the clinical characteristics of this infection. We searched the medline database for articles published in the English-language literature since 1970 and carefully analyzed 87 cases. The main risk factors were diabetes mellitus, hematologic cancers, renal insufficiency, and organ transplantation. Several patients had no apparent immune compromise. There was a predilection for involvement of the upper lobes. air crescent signs on chest x-ray films were predictors of pulmonary hemorrhage and death from hemoptysis. Fiberoptic bronchoscopy was a useful diagnostic method, and histopathologic examination was more sensitive than fungal cultures. The overall survival rate was 44%. patients treated with a combined medical-surgical approach had a better outcome than patients who did not undergo surgery. Thus, this relatively rare but often fatal disease should be suspected in immunocompromised patients who fail to respond to antibacterial therapy. Early recognition and aggressive management are warranted to maximize chances for cure. Optimal therapy requires systemic antifungal therapy, surgical resection, and, when possible, control of the patient's underlying disease. ( info) |
10/700. Cryptic Mucor infection leading to massive cerebral infarction at initiation of antileukemic chemotherapy. A 74-year-old man with newly diagnosed acute myelogenous leukemia unexpectedly suffered a massive cerebral infarct on day 2 of induction chemotherapy. Clinically, the hemorrhagic infarct was thought to be due to leukostasis and thrombocytopenia. Necropsy, however, revealed that Zygomycetes-type hyphae had infiltrated cerebral vessels in and near the infarct. The fungal infection was clinically silent otherwise, although fungal elements were also identified in the lung at autopsy. This case illustrates how closely fungal infection may resemble a leukemia-associated cerebrovascular accident. ( info) |