Mucormycosis of the liver: CT findings

Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings

Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.

Delayed Graft Dysfunction due to Invasive Hepatic Mucormycosis After Living Donor Liver Transplantation

Mucormycosis is a rare but emerging fungal infection complicating solid organ transplantation. It is associated with a high mortality rate. We describe an unusual case of hepatic mucormycosis in a living donor liver transplant recipient presenting as delayed graft dysfunction, which was successfully treated with combination of liposomal amphotericin B and oral posaconazole therapy, without surgical resection. The patient had clinical improvement with normalization of liver function tests.

A Young, Immunocompetent Woman with Small Bowel and Hepatic Mucormycosis Successfully Treated with Aggressive Surgical Debridements and Antifungal Therapy

A 24-year-old woman with coeliac disease and transient neutropenia developed mucormycosis with extensive involvement of the liver and small intestine. She was successfully treated with aggressive surgical debridements and long-term antifungal therapy with liposomal amphotericin B and posaconazole.

"An unusual presentation of colonic mucormycosis mimicking carcinoma colon- a surgeon's perspective"

INTRODUCTION

Mucormycosis caused by order mucorales, an ubiquitous saprophytic mold found in soil and organic matter worldwide, is a rare but invasive opportunistic fungal infection. Gastrointestinal mucormycosis is the most uncommon clinical presentation being particularly rare, accounted for 4-7% of all cases.

PRESENTATION OF CASE

We report an unusual presentation of mucormycosis of ascending colon that was simulating carcinoma colon.

DISCUSSION

GI mucormycosis most commonly involves the stomach (57.5%), followed by the colon (32.3%) and the ileum (6.9%). Initial presentations may be abdominal pain and distension, fever, and diarrhoea. Colonic mucormycosis presenting as a mass with altered bowel habit, melena and abdominal pain in our case is extremely difficult to differentiate it from carcinoma colon. A definitive diagnosis of mucormycosis is almost always ascertained by histopathological evidence of fungal invasion of tissue.

CONCLUSION

Knowing these unusual presentations of this disease, surgeon need to maintain a high index of suspicion and perform timely and appropriate diagnostic evaluation to improve patient outcome. Prompt diagnosis, reversal of predisposing conditions, and aggressive surgical debridement remain cornerstones of therapy for this deadly disease.

Hepatic mucormycosis in a patient of acute lymphoblastic leukemia: a case report with literature review

Mucormycosis is an invasive opportunistic fungal infection associated with a high mortality rate, and normally occurs in immunocompromised patients. It can be encountered during neutropenia following chemotherapy in acute leukemia patients. The common sites involved are rhinocerebral, pulmonary, gastrointestinal and spleen. Hepatic involvement has been reported rarely. We hereby report a case of acute lymphoblastic leukemia who while on chemotherapy developed hepatic mucormycosis and was managed successfully despite its treatment being quite challenging, especially in the context of surgery in a neutropenic sick patient.

Hepatic mucormycosis mimicking hilar cholangiocarcinoma: A case report and literature review

Mucormycosis is a rare but invasive opportunistic fungal infection associated with a high mortality rate, and normally occurs in immunocompromised patients. In this report, we describe an immunocompetent patient suffering from hepatic mucormycosis secondary to adrenal mucormycosis, which masquerades as hilar cholangiocarcinoma. After surgical procedure and treatment with amphotericin B and itraconazole, the patient recovered well and had a 2-year infection-free survival. To our knowledge, this special clinical manifestation of hepatic infection as well as adrenal mucormycosis has not been reported to date. Meanwhile, this is the first case of an immunocompetent patient with both adrenal and hepatic mucormycosis who has been treated successfully.

Imagerie des formes viscérales graves de la mucormycose chez 5 patients immunodéprimés

OBJECTIVES

Show the contribution of imaging to the diagnosis and follow-up of serious mucormycosis in immunodepressed patients.

MATERIALS AND METHODS

Retrospective analysis of the 5-year radiological data in serious forms of mucormycosis occurring in patients with bone marrow allografts who are in refractory chronic graft-versus-host disease after bone marrow transplantation from 2002 to 2005. The positive diagnosis was bacteriologically and pathologically positive in all cases.

RESULTS

This study involved three patients with isolated pulmonary involvement and two cases of disseminated mucormycosis. Areas of pulmonary condensations were found in all cases, one of whom had a low-attenuation zone and parenchymal nodules. The kidney, liver, and spleen lesions were clearly limited, hypoechogenic, hypodense, and homogenous with no peripheral contrast material uptake. There was thyroid involvement in the form of hypoechogenic nodules. Rapid growth of the lesions was observed on follow-up CT (n=3) and despite surgical treatment (n=2) and intensive medical management, all cases ended in death.

CONCLUSION

Mucormycosis is an integral part of the differential diagnosis of infectious syndromes in immunodepressed patients during the period after bone marrow transplantation. Imaging can assist in the diagnosis but pathological confirmation remains indispensable.

Two cases of hepatic zygomycosis in allogeneic stem cell transplant recipients and review of literature

Gastrointestinal zygomycosis is a rare condition with a high mortality rate. We present 2 fatal cases of hepatic zygomycosis following allogeneic hematopoietic stem cell transplantation and review the literature.