Disseminated Rhizopus microsporus infection in a patient on oral corticosteroid treatment: a case report.
A 71-year-old male with mild steroid-induced hyperglycaemia was diagnosed with a lethal invasive Rhizopus microsporus infection. Disseminated zygomycosis is a rare entity and is most frequently found in neutropenic patients with haematological malignancies, post-transplants or in patients on deferoxamine therapy. Infection is characterised by tissue infarction and necrosis due to angioinvasive hyphae. Culture of Zygomycetes is necessary for species determination but histology is a must to prove the infection. Ante-mortem diagnosis and culture is challenging and therefore mortality approaches 100%. Apart from amphotericine B, most anti-fungals have no activity against Zygomycetes but posaconazole might offer new possibilities as a first-line agent. Timely diagnosis, rapid surgery of infected tissue, correction of underlying disorders and correct anti-fungal therapy might be life-saving. Due to the increasing use of potent immunosuppression, stem cell and organ transplants and possibly selection for Zygomycetes by prior treatment with broad-spectrum antifungal therapy, the incidence of zygomycosis is rising. Therefore, clinicians might encounter an increasing number of zygomycosis cases in the near future.
de Mol
P
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Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands. P.d.Mol@cwz.nl
Meis
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JF
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D009091:Mucormycosis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D011239:Prednisolone / Q000009:adverse effects; D011743:Pyrimidines / Q000627:therapeutic use; D012233:Rhizopus; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; D002939:Ciprofloxacin; D000658:Amoxicillin; D011239:Prednisolone; D065819:Voriconazole