Disseminated Mucormycosis with Extensive Cardiac Involvement

Abstract

Mucormycosis is an opportunistic fungal infection. Cardiac involvement is a rare, yet fatal, complication that can occur in disseminated disease. A strong index of suspicion is necessary for prompt treatment, especially in high-risk patients. We present a 62-year-old male patient with a history of diabetes and acute myeloid leukemia; he had pulmonary mucormycosis that was complicated by cardiac involvement as part of disseminated mucormycosis syndrome.

Keywords: amphotericin b; cardiac imaging; disseminated infection; invasive mucormycosis; opportunistic infection.

Figure 1. Axial (A and B) chest CT

Multifocal bilateral airspace disease with areas of interval cavitation (arrows), consistent with evolving and partially treated sequela of multifocal infection. There are also small bilateral pleural effusions, greater on the left.

Figure 2. Axial chest CT

CT-guided biopsy of a left upper lobe cavitary lesion (the yellow arrow) CT: computed tomography

Figure 3. Left lung nodule touch prep 40x

Broad, aseptate, ribbon-like hollow hyphae with right angle branching, compatible with zygomycete species

Figure 4. Left lung nodule hematoxylin and eosin stain (H&E) stain

Angioinvasion by broad, aseptate, ribbon-like hollow hyphae with right angle branching, compatible with zygomycete species

Figure 5. Left lung nodule Gomori's Methenamine Silver (GMS) stain

Angioinvasion by broad, aseptate, ribbon-like hollow hyphae with right angle branching, compatible with zygomycete species

Figure 6. Echocardiogram

Mass (arrow) inside the right atrium

Figure 7. Cardiac magnetic resonance imaging

(A) Four chamber view T2 dark blood magnetic resonance imaging (MRI); (B) short axis view cine steady-state free precession MRI; and (C) four-chamber view. T1 fat saturated post-gadolinium contrast MRI demonstrates a non-enhancing mass (asterisk) extending between the right atrium and right ventricle through the tricuspid valve. The mass has a friable component in the right atrium that is freely mobile (arrow). This mass was thought to represent a thrombus, with or without superinfection.

Figure 8. Right atrial mass Gomori's Methenamine Silver (GMS) stain 40x

Degenerating fungal hyphal forms