Renal mucormycosis caused by Apophysomyces species: case report and literature review

Mucormycosis represents an uncommon yet aggressive and life-threatening fungal infection, typically occurring in immunocompromised individuals. Unlike most Mucorales infections, Apophysomyces frequently infects otherwise healthy hosts, raising significant clinical concern. Alarmingly its atypical manifestation, necrotizing fasciitis, is often misdiagnosed as a bacterial infection due to overlapping clinical features.

Herein we present a case of Apophysomyces infection in kidney in an immunocompetent 52-year-old man, whose condition deteriorated swiftly, leading to failure of several organs, culminating in death. All laboratory results, including serological assays and microbial cultures from blood, respiratory secretions, urine, and stool, showed no abnormalities. The diagnosis was confirmed through metagenomic next-generation sequencing (mNGS) which was highlighted as valuable for early diagnosis. We conducted a literature review of 13 cases previously reported from 1994 to 2025, implying a higher prevalence among immunocompetent individuals. Patients of Indian constituted the majority across all reported cases. PCR, fungal culture and histopathological examination served as the primary diagnostic methods. Systemic antifungal agents were administered to 13 individuals, while surgical intervention was performed in 8 cases. Complete recovery was achieved in 7 patients.

Therefore our report highlights Apophysomyces variabilis as a novel pathogen of clinical importance in China, emphasizing that mortality rates escalate substantially without timely detection and appropriate management.