Diverse Presentations of Invasive Aspergillus and Mucorales Infections in Immunocompromised Patients: A Case Series

Invasive fungal infections (IFIs) pose significant challenges in immunocompromised patients, particularly those with diabetes, malignancies, HIV, COVID-19, or prolonged corticosteroid use. Invasive infections due to Aspergillus and Mucorales, alone or in combination, are increasingly recognized, often with atypical presentations. These fungal infections can mimic bacterial or tubercular diseases and pose significant therapeutic challenges, as their management requires tailored antifungal regimens, particularly in cases of co-infections. We present three cases of diverse presentations of Aspergillus and Mucorales infections in immunocompromised patients. Case 1: A 65-year-old male with renal and bladder carcinoma developed a cavitary pulmonary lesion; bronchoalveolar lavage grew Aspergillus niger, and a concurrent urinary tract infection with Enterococcus faecium was identified. Case 2: A 58-year-old diabetic male presented with right-sided rhinosinusitis and visual loss; surgical biopsy demonstrated Rhizopus arrhizus and Aspergillus flavus. Case 3: A 70-year-old diabetic male with respiratory distress was found to have a hepatic abscess with pleuro-peritoneal extension due to Rhizopus pusillus; sputum cultures additionally yielded Aspergillus fumigatus. These cases underscore the evolving clinical spectrum of Aspergillus and Mucorales infections. High clinical suspicion, timely imaging, and microbiological confirmation are critical for early diagnosis. Optimal management requires a multidisciplinary approach, combining surgical intervention, targeted antifungal therapy, and control of underlying risk factors. Reporting such rare and atypical presentations contributes to improved awareness and evidence-based strategies in managing these life-threatening infections.