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Meyerowitz EA, Sanchez S, Mansour MK, Triant VA, Goldberg MB. Isolated Cerebral Mucormycosis in Immunocompetent Adults who Inject Drugs: Case Reports and Systematic Review of the Literature. Open Forum Infect Dis 2020; 7:ofaa552. [PMID: 33409328 PMCID: PMC7765436 DOI: 10.1093/ofid/ofaa552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 01/16/2023] Open
Abstract
Background Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe 2 cases of isolated cerebral mucormycosis in immunocompetent adults and describe this syndrome in detail in the context of a systemic literature review. Methods Using the criteria (1) isolated cerebral disease, (2) mucormycosis (by polymerase chain reaction, culture, or pathology), and (3) affected an immunocompetent individual, we identified 53 additional cases from 1969 to 2020. Results Of these 55 cases, ~60% occurred in men, >70% were in patients under age 35, 92% were associated with intravenous drug use, and >85% had infection centered in the basal ganglia. Many presented with cranial nerve deficits, headache, focal weakness, or altered mental status. Conclusions No patient survived without amphotericin, and steroid administration was associated with worse outcomes. Given the current opioid crisis, this syndrome may be seen more frequently.
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Affiliation(s)
- Eric A Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarimer Sanchez
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael K Mansour
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Virginia A Triant
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcia B Goldberg
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
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Elzein F, Kalam K, Mohammed N, Elzein A, Alotaibi FZ, Khan M, Albadani A. Treatment of cerebral mucormycosis with drug therapy alone: A case report. Med Mycol Case Rep 2019; 23:4-7. [PMID: 30425919 PMCID: PMC6222173 DOI: 10.1016/j.mmcr.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/26/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023] Open
Abstract
We report on an elderly male patient with headache and right-side weakness. Imaging studies revealed multiple space-occupying lesions in the parietal and occipital cerebral regions. Biopsy revealed broad aseptate ribbon-like structures branching at right angles, suggestive of mucormycosis. Improvement was observed after medical therapy with 20 weeks of liposomal amphotericin B (5 mg/kg/day) combined with posaconazole, followed by posaconazole (400 mg twice a day) alone for 1 month. The patient recovered without neurological deficits; however, multidrug-resistant bacteraemia and hospital-acquired pneumonia occurred, resulting in death. Nevertheless, our report shows that this lethal fungal infection can sometimes show favourable progress with drug therapy alone.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Kiran Kalam
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Nazik Mohammed
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Ahmed Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Mujtaba Khan
- Department of Radiology, PSMMC, Riyadh, Saudi Arabia
| | - Abeer Albadani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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3
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Ma J, Jia R, Li J, Liu Y, Li Y, Lin P, Zhang M, Li M. Retrospective Clinical Study of Eighty-One Cases of Intracranial Mucormycosis. J Glob Infect Dis 2016; 7:143-50. [PMID: 26752868 PMCID: PMC4693305 DOI: 10.4103/0974-777x.170497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Fungal infections of the central nervous system, especially cerebral mucormycosis or brain abscess are very rare.Cerebral mucormycosis is a rare disease. It is not an independent disease, but a secondary opportunistic infectious disease. Materials and methods: This study has collected the data of 81 cases of intracranial mucormycosis from 28 Chinese hospitals, within 37 years, as well as reviewed the literatures and retrospectively analyzed and summarized this disease's background, clinical classifications, risk factors, pathology, clinical manifestations, diagnosis, treatment, and prognosis. Results: The 81 IM cases were aged between 15 days (the youngest) and 79 years (oldest), with a mean age of 41.6 years. Among them, 12 cases were <1 year old (the infant group), six cases were within one to 13 years old (the children group), and 63 cases were >14 years old (the adult group ). 45 cases were male and 36 were female, with a male/female ratio of 1.25:1.0. The shortest duration of the disease was three days, and the longest was 248 days. Conclusions: This study helped to realize an early diagnosis and treatment, improve the cure rate, and reduce mortality.
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Affiliation(s)
- Jinjian Ma
- Department of Neurosurgery, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Ruichao Jia
- Department of Neurosurgery, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Jin Li
- Department of Neurosurgery, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Yunyang Liu
- Department of Neurosurgery, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Yuming Li
- Department of Hematology, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Peng Lin
- Department of Otolaryngology-Head and Neck Surgery, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Mingmu Zhang
- Department of Pathology, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
| | - Mu Li
- Department of Neurosurgery, First Central Hospital, No 24 Fukang Road, Nankai, Tianjin, China
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Malik AN, Bi WL, McCray B, Abedalthagafi M, Vaitkevicius H, Dunn IF. Isolated cerebral mucormycosis of the basal ganglia. Clin Neurol Neurosurg 2014; 124:102-5. [PMID: 25019460 DOI: 10.1016/j.clineuro.2014.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Athar N Malik
- Harvard Medical School, Boston, MA, United States; Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Brett McCray
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Malak Abedalthagafi
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States.
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Lin TP, Thompson R, Coull B. A 28-year-old i.v. drug user with bilateral basal ganglia and brainstem lesions. Neurology 2013; 80:e73-6. [PMID: 23400323 PMCID: PMC3590060 DOI: 10.1212/wnl.0b013e318281cd02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tanya P Lin
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
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Han SR, Choi CY, Joo M, Whang CJ. Isolated cerebral mucormycosis. J Korean Neurosurg Soc 2007; 42:400-2. [PMID: 19096577 PMCID: PMC2588197 DOI: 10.3340/jkns.2007.42.5.400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 09/19/2007] [Indexed: 11/27/2022] Open
Abstract
Isolated cerebral mucoromycosis, without rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis diagnosed by open biopsy and treated with amphotericin B. The patient has returned to independent living.
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Affiliation(s)
- Seong Rok Han
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Chan Young Choi
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Mee Joo
- Department of Pathology, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Choong Jin Whang
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
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