title: Pulmonary mucormycosis due to Lichtheimia ramosa in a patient with HIV infection.
abstract: Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm(3). The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi's sarcoma or severe immunodeficiency, as in our case.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey, muratkutlu72@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Kutlu
authors.forename: Cağrı
authors.initials: C
authors.lastname: Ergin
authors.forename: Ferda
authors.initials: F
authors.lastname: Bir
authors.forename: Süleyha
authors.initials: S
authors.lastname: Hilmioğlu-Polat
authors.forename: Ramazan
authors.initials: R
authors.lastname: Gümral
authors.forename: Ceyda
authors.initials: C
authors.lastname: Necan
authors.forename: Ali
authors.initials: A
authors.lastname: Koçyiğit
authors.forename: Selda
authors.initials: S
authors.lastname: Sayın-Kutlu
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D000935:Antifungal Agents / Q000494:pharmacology; D018791:CD4 Lymphocyte Count; D025141:Drug Resistance, Fungal; D017809:Fatal Outcome; D006651:Histocytochemistry; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009090:Mucorales / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D013183:Sputum / Q000382:microbiology
chemical_list: D000935:Antifungal Agents