Case Report of International Journal of Case Reports
Multiple septic emboli and myocardial infarction due to vaso-invasive Rhizomucor pusillus infection in a hematologic patient
Pim A. de Ruijter, MD, 1,Pui-Yuen Lee, MD, 2,Judith Bonnes, MD, PhD, 3,Monika G. Looijen-Salamon, MD, 2, Johannes G. van der Hoeven, MD, PhD, 1
1Department of Intensive Care, Radboud University Medical Centre Nijmegen, The Netherlands;
2Department of Pathology,Radboud University Medical Centre Nijmegen, The Netherlands;
3 Department of Cardiology, Radboud University Medical Centre Nijmegen, The Netherlands
We present a case of a 63-year-old hematologic patient with pulmonary vaso-invasive zygomycosis with Rhizomucor pusillus after a second stem cell transplantation (SCT) for myelodysplastic syndrome, complicated by multi organ failure, myocardial ischemia and infarction. Zygomycosis is common in immunocompromised patients, especially after hematopoietic stem cell transplantation (HSCT). Mucor species have devastating vaso-invasive properties causing hematogenic dissemination. Antemortem diagnosis may be difficult due to negative cultures. Despite adequate treatment outcome tends to be poor. Cardiac zygomycosis is rare. In our patient, the clinical course and imaging results of the myocardial infarction are most consistent with coronary plaque rupture possibly provoked by severe vaso-invasive pulmonary infection and multi-organ failure.
Keywords: Multiple septic emboli and myocardial infarction; vaso-invasive Rhizomucor pusillus infection; hematologic patient
How to cite this article:
Pim A. de Ruijter, Pui-Yuen Lee,Judith Bonnes, Monika G. Looijen-Salamon, Johannes G. van der Hoeven. Multiple septic emboli and myocardial infarction due to vaso-invasive Rhizomucor pusillus infection in a hematologic patient. International Journal of Case Reports, 2021 5:227. DOI: 10.28933/ijcr-2021-06-2305
1. Freifeld, A. and P. Iwen, Zygomycosis. Semin Respir Crit Care Med, 2004. 25: p. 221-31.
2. Ruping, M.J., et al., Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother, 2010. 65(2): p. 296-302.
3. Chen, Q., et al., Disseminated mucormycosis with cerebellum involvement due to Rhizomucor pusillus in a patient with multiple myeloma and secondary myelodysplastic syndrome: A case report. Exp Ther Med, 2019. 18(5): p. 4076-4080.
4. Rawlinson, N.J., et al., Disseminated Rhizomucor pusillus causing early multiorgan failure during hematopoietic stem cell transplantation for severe aplastic anemia. J Pediatr Hematol Oncol, 2011. 33(3): p. 235-7.
5. Feng, J. and X. Sun, Characteristics of pulmonary mucormycosis and predictive risk factors for the outcome. Infection, 2018. 46(4): p. 503-512.
6. Mehta, N.N., J. Romanelli, and M.G. Sutton, Native aortic valve vegetative endocarditis with Cunninghamella. Eur J Echocardiogr, 2004. 5(2): p. 156-8.
7. Webb, B.J., et al., Concurrent pulmonary Aspergillus fumigatus and mucor infection in a cardiac transplant recipient: a case report. Transplant Proc, 2013. 45(2): p. 792-7.
8. Nolan, R.L., et al., Subacute disseminated mucormycosis in a diabetic male. Am J Med Sci, 1989. 298(4): p. 252-5.
9. Tansir, G., et al., Disseminated mucormycosis: A sinister cause of neutropenic fever syndrome. Intractable Rare Dis Res, 2017. 6(4): p. 310-313.
10. Krishnappa, D., et al., Cardiac mucormycosis: a case report. Eur Heart J Case Rep, 2019. 3(3).
11. Jackman, J.D., Jr. and R.L. Simonsen, The clinical manifestations of cardiac mucormycosis. Chest, 1992. 101(6): p. 1733-6.
12. Nam, Y., et al., Disseminated mucormycosis with myocardial involvement in a renal transplant recipient. Transpl Infect Dis, 2015. 17(6): p. 890-6.
13. Ferreira, D., et al., Acute myocardial infarction in disseminated mucormycosis infection. Eur Heart J, 2017. 38(11): p. 838.
14. Virmani, R., D.H. Connor, and H.A. McAllister, Cardiac mucormycosis. A report of five patients and review of 14 previously reported cases. Am J Clin Pathol, 1982. 78(1): p. 42-7.
15. Sanchez-Recalde, A., et al., Successful treatment of prosthetic aortic valve mucormycosis. Chest, 1999. 116(6): p. 1818-20.
16. Chinen, K., et al., Fungal infections of the heart: a clinicopathologic study of 50 autopsy cases. Pathol Res Pract, 2007. 203(10): p. 705-15.
17. Patel, A., et al., A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India. Clin Microbiol Infect, 2020. 26(7): p. 944 e9-944 e15.
18. Ibrahim, A.S., B. Spellberg, and J. Edwards, Jr., Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Curr Opin Infect Dis, 2008. 21(6): p. 620-5.
19. St-Germain, G., et al., Infection due to Rhizomucor pusillus: report of four cases in patients with leukemia and review. Clin Infect Dis, 1993. 16(5): p. 640-5.
20. Kimura, M., et al., Isolation and identification of Rhizomucor pusillus from pleural zygomycosis in an immunocompetent patient. Med Mycol, 2009. 47(8): p. 869-73.
21. Hosseini, S.M. and P. Borghei, Rhinocerebral mucormycosis: pathways of spread. Eur Arch Otorhinolaryngol, 2005. 262(11): p. 932-8.
22. Hussain, S., et al., Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals. Eur J Radiol, 1995. 20(2): p. 151-5.
23. Hassan, W., et al., Enhancement of iron-catalyzed lipid peroxidation by acidosis in brain homogenate: comparative effect of diphenyl diselenide and ebselen. Brain Res, 2009. 1258: p. 71-7.
24. Kontoyiannis, D.P., et al., Increased bone marrow iron stores is an independent risk factor for invasive aspergillosis in patients with high-risk hematologic malignancies and recipients of allogeneic hematopoietic stem cell transplantation. Cancer, 2007. 110(6): p. 1303-6.
25. Roden, M.M., et al., Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis, 2005. 41(5): p. 634-53.
26. Lee, F.Y., S.B. Mossad, and K.A. Adal, Pulmonary mucormycosis: the last 30 years. Arch Intern Med, 1999. 159(12): p. 1301-9.
27. Tedder, M., et al., Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg, 1994. 57(4): p. 1044-50.
28. Jeong, W., et al., The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect, 2019. 25(1): p. 26-34.
29. Spellberg, B., J. Edwards, Jr., and A. Ibrahim, Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev, 2005. 18(3): p. 556-69.
30. Neofytos, D., et al., Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis, 2009. 48(3): p. 265-73.
31. Chamilos, G., R.E. Lewis, and D.P. Kontoyiannis, Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis, 2008. 47(4): p. 503-9.
This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.