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Rhizopus arrhizus and Fusarium solani Concomitant Infection in an Immunocompromised Host

João N de Almeida Júnior1,2, Karim Y Ibrahim3, Gilda M B Del Negro4

  • 1Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil. jnaj99@gmail.com.

Mycopathologia
|September 9, 2015
PubMed

Insights

Neutropenic patients can develop rare, co-occurring fungal infections like mucormycosis and fusariosis. This case highlights the need for advanced diagnostics to identify dual mold infections in immunocompromised individuals.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Neutropenic patients, particularly those with acute myeloid leukemia, face a high risk of invasive fungal infections, including mucormycosis and hyalohyphomycosis.
  • Accurate and timely diagnosis is critical for effective treatment, yet concurrent mold infections are infrequently documented.
  • Distinguishing between different mold infections can be challenging, impacting therapeutic strategies.

Observation:

  • A case of a neutropenic patient with acute myeloid leukemia who developed a rhino-orbital infection caused by Rhizopus arrhizus (mucormycosis).
  • A subsequent disseminated infection by Fusarium solani (fusariosis) was diagnosed, leading to clinical deterioration.
  • Initial biopsies yielded discordant results, with one suggesting mucormycosis and a later one indicating hyalohyphomycosis.

Findings:

  • Review of the second biopsy revealed hyphae consistent with both mucormycetes and hyalohyphomycetes, indicating a dual mold infection.
  • Polymerase chain reaction (PCR) assays on paraffinized tissue sections confirmed the presence of both Rhizopus arrhizus and Fusarium solani.
  • This unprecedented case demonstrates concomitant mucormycosis and fusariosis in a single immunocompromised patient.

Implications:

  • Increased clinical awareness of dual mold infections in at-risk populations, such as neutropenic patients, is essential.
  • Utilizing PCR methods on tissue sections can improve the diagnostic yield for co-existing fungal infections.
  • Discrepant findings from sequential biopsies should prompt suspicion of mixed or concomitant infections, necessitating further investigation.
Keywords:
Fusarium solaniNeutropeniaPCR methodsParaffin-embedded tissue sectionRhizopus arrhizus

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