Myocardial infarct in disseminated mucormycosis: case report with special emphasis on the pathogenic mechanisms.

A case of myocardium infarction in generalized mucormycosis is reported in a patient suffering from chronic renal failure and receiving a cadaver kidney transplant. At autopsy we found a recent necrotic myocardium, coronary vessels occluded by mucor hyphae and a striking absence of inflammatory cells, chiefly neutrophils. Ultrastructural studies revealed thick-walled fungus that participate in the thrombus and cross the coronary artery in a 'corkscrew' pattern, without important cellular degeneration. Thin-walled irregularly branching structures were observed occluding the microcirculation of still preserved cardiac areas. These structures could be originated from the fungus cells that had lost their thick laminated wall, leaving the plasmatic membrane as external coat. Special emphasis is given to the relation between the poor coronary vascular protection against mucormycosis and the neutrophilic disfunction. The lungs are the main site of primary infection. This disease is underdiagnosed in vivo and leads always to death.