Fatal Cerebral Complications in Disseminated Mucormycosis after Influenza-associated Pneumonia in an Immunocompromised Patient: An Autopsy Case Report
Masashi Watanabe1, Yoshito Homma1, Satoshi Sumida1, Akira Watanabe2, Ryuichiro Hiyama1, Kyosuke Saeki1, Koichi Nakase1, Yoshiyasu Hiratsuka1, Yoshihio Ohtsuka1, Akira Yoshida1, Haruki Ohtsubo1, Akira Shiraoka1, Itaru Kyoraku1, Kensho Okamoto1
1Ehime Prefectural Central Hospital, 2Chiba University Medical Mycology Research Center
Objective:
We aim to report the clinical characteristics and appropriate diagnostic approaches for a rare fatal case of cerebral complications in disseminated mucormycosis after influenza-associated pneumonia in an immunocompromised patient.
Background:
Disseminated mucormycosis is a severe fungal infection that primarily affects immunocompromised individuals and often results in tissue infarction and high mortality rates. Diagnosis and treatment are challenging because of poor blood culture sensitivity and lack of serological markers.
Results:
A 75-year-old woman with uncontrolled diabetes, high-risk myelodysplastic syndrome (h-MDS), and IgG4-related disease, treated with long-term prednisolone, presented with fever and mild consciousness disturbance. On admission, she exhibited pancytopenia, elevated inflammatory markers, and a positive influenza A test. Chest CT showed influenza-associated pneumonia with organizing pneumonia. Despite treatment with cefepime, peramivir, and increased corticosteroids, her condition worsened, leading to left hemiplegia and severe consciousness disturbance on hospital day 3. Brain MRI on day 8 showed bilateral ischemic strokes, and contrast MRI on day 9 indicated progressive ischemic strokes, leptomeningitis, and vasculitis. CSF analysis revealed increased leukocyte count and elevated IL-6, but cultures and cytology were negative. Despite intensive care, she succumbed to extensive hemorrhagic cerebral infarction and midbrain herniation by day 13. Postmortem examination identified widespread fungal infection due to Rhizomucor miehei, along with pulmonary infarction and renal involvement. The final diagnosis was cerebral infarction with vasculitis and encephalomeningitis secondary to disseminated mucormycosis following influenza-associated pneumonia.
Conclusions:
This rare case underscores the need to consider opportunistic infections, such as mucormycosis, in immunocompromised patients exhibiting neurological symptoms post-influenza. Early identification and antifungal treatment are crucial for improving outcomes in similar cases. Advanced diagnostic techniques may enhance the detection and management of such infections.
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