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Case Reports
. 2016 Aug 30;3(4):e005048.
doi: 10.1099/jmmcr.0.005048. eCollection 2016 Aug.

Angioinvasive mucormycosis and paradoxical stroke: a case report

Roxana Mititelu  1 , Samuel Bourassa-Blanchette  2 , Karan Sharma  3 , Virginia Roth  3
Affiliations
Case Reports

Angioinvasive mucormycosis and paradoxical stroke: a case report

Roxana Mititelu et al. JMM Case Rep. .

Abstract

Introduction: Rhizopus typically results in acute, aggressive and angioinvasive infection, particularly in immunosuppressed individuals. Risk factors include immunosuppression in haematologic malignancy, uncontrolled hyperglycemia, iron overload states, and older chelator agents such as deferoxamine.

Case presentation: We describe a case of a 33-year-old female with transfusion-dependent beta thalassemia who was started on intravenous deferiprone therapy and subsequently presented with a retropharyngeal abscess. Despite intravenous broad spectrum antibiotics, she continued to deteriorate and developed aphasia. A CT scan of her head showed multiple hypodensities. Blood cultures grew Rhizopus species and a subsequent transesophageal echocardiogram showed a mass in the right atrium with a patent foramen ovale.

Conclusion: Although deferiprone, a newer iron chelator agent, has antifungal properties in vivo, this case illustrates that angioinvasive Rhizopus infections can occur in patients treated with deferiprone.

Keywords: Mucormycosis; PFO; antifungal; aphasia; infectious endocarditis; iron chelator; stroke.

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Figures

Fig. 1.
Fig. 1.
(a) MRI axial T2 FLAIR image demonstrating bilateral frontal acute infarction (b) MRI axial demonstrating acute left occipital and subactue caudate stroke.
Fig. 2.
Fig. 2.
Gross section of the intracardiac mass (a); cotton blue mount showing characteristic microscopic morphology of Rhizopus isolate (b); calcofluor white mount showing hyphae in the tissue (c); non-septate hyphal elements in the resected mass stained with Gram stain (d); Gomori methenamine silver stain showing aseptate hyphae in the tissue (e).
See this image and copyright information in PMC

References

    1. Boelaert J. R., de Locht M., Van Cutsem J., Kerrels V., Cantinieaux B., Verdonck A., Van Landuyt H. W., Schneider Y. J.(1993). Mucormycosis during deferoxamine therapy is a siderophore-mediated infection. In vitro and in vivo animal studies. J Clin Invest 911979–1986. 10.1172/JCI116419 - DOI - PMC - PubMed
    1. Brittenham G. M., Griffith P. M., Nienhuis A. W., McLaren C. E., Young N. S., Tucker E. E., Allen C. J., Farrell D. E., Harris J. W.(1994). Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med 331567–573. 10.1056/NEJM199409013310902 - DOI - PubMed
    1. Caes F. L., Van Belleghem Y. V., Missault L. H., Coenye K. E., Van Nooten G. J.(1995). Surgical treatment of impending paradoxical embolism through patent foramen ovale. Ann Thorac Surg 591559–1561. - PubMed
    1. Falk V., Walther T., Krankenberg H., Mohr F. W.(1997). Trapped thrombus in a patent foramen ovale. Turk Kardiyol Dern Ars 4590–92. - PubMed
    1. Jackman J. D., Simonsen R. L.(1992). The clinical manifestations of cardiac mucormycosis. CHEST Journal 1011733–1736. - PubMed

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