Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Mucormycosis 1005

➣Vision loss may be due to retinal artery thrombosis.

➣Ptosis and dilation of pupils seen if cranial nerve involvement

■Pulmonary:

➣Usually found in neutropenic cancer patients, usually have

received broad-spectrum antibiotics in the hospital

➣May present with fever and dyspnea; hemoptysis if vessel inva-

sion

■Cutaneous:

➣Primary: results from direct inoculation of the organism into the

skin

➣Necrosis may develop if there is vessel invasion

➣Secondary: develops as a result of fungemia

■GI:

➣Found in patients with severe malnutrition

■May be introduced with contaminated food

➣Abdominal pain, nausea, vomiting, fever and hematochezia pos-

sible

■CNS:

➣Usually via extension from sinuses or nose into brain

➣Altered mental status, cranial nerve findings

➣If via direct inoculation via trauma into brain, may present as

black discharge from wound

tests

Laboratory

■Basic studies: blood culture rarely positive

■Basic studies: serology not used

■Basic studies: tissue biopsy

➣Fungal hyphae can be seen in tissue that has been hematoxylin

and eosin, methenamine silver or periodic acid-Schiff stai-

ned

■The fungi appear as broad, nonseptate hyphae with right angle

branching.

Imaging

■Rhinocerebral mucormycosis:

■Sinus films: mucosal thickening, air-fluid levels possible

■CT may better define eroded bone in more advanced disease.

■MRI also used, with similar findings

■Pulmonary mucormycosis:

■Chest X-ray: consolidation (66%), cavitation (40%)