title: [Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient].
abstract: BACKGROUND
  Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported.
  
  
  METHODS
  A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications.
  
  
  CONCLUSIONS
  Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, IMIBIC, CIBERehd, Córdoba, España. Electronic address: juancarlos.pozo@ono.com.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Pozo-Laderas
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pontes-Moreno
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Robles-Arista
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Bautista-Rodriguez
authors.affiliation: Servicio de Cirugía Máxilo-Facial, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Candau-Alvarez
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Caro-Cuenca
authors.affiliation: Servicio de Microbiología, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: María José
authors.initials: MJ
authors.lastname: Linares-Sicilia
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000405:Akinetic Mutism / Q000209:etiology; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D001234:Aspergillus niger / Q000302:isolation & purification*; D060085:Coinfection / Q000188:drug therapy / Q000382:microbiology; D003131:Combined Modality Therapy; D006259:Craniocerebral Trauma / Q000150:complications* / Q000601:surgery; D003422:Critical Care / Q000379:methods; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000601:surgery; D006801:Humans; D007121:Immunocompetence; D008172:Lung Diseases, Fungal / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D008297:Male; D009091:Mucormycosis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011183:Postoperative Complications / Q000382:microbiology; D020103:Rhizomucor / Q000302:isolation & purification*; D012887:Skull Fractures / Q000209:etiology / Q000601:surgery; D014456:Ulcer / Q000209:etiology / Q000601:surgery; D014946:Wound Infection / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B
keywords: Anfotericina B liposomal; Aspergilosis pulmonar; Disseminated mucormycosis; Immunocompetent; Infección fúngica invasiva mixta; Inmunocompetente; Liposomal amphotericin B; Mixed invasive fungal infection; Mucormicosis diseminada; Pulmonary aspergillosis; Rhizomucor pusillus