Juan Carlos Pozo-Laderas1, Antonio Pontes-Moreno2, Juan Carlos Robles-Arista2, M Dolores Bautista-Rodriguez2, Alberto Candau-Alvarez3, Maria Teresa Caro-Cuenca4, María José Linares-Sicilia5. 1. Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, IMIBIC, CIBERehd, Córdoba, España. Electronic address: juancarlos.pozo@ono.com. 2. Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España. 3. Servicio de Cirugía Máxilo-Facial, Hospital Universitario Reina Sofía, Córdoba, España. 4. Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España. 5. Servicio de Microbiología, Hospital Universitario Reina Sofía, Córdoba, España.
Abstract
BACKGROUND: Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT: A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. CONCLUSIONS: Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.
BACKGROUND:Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT: A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. CONCLUSIONS: Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.