An autopsied case of zygomycosis invasing in the central nervous system and vessels, which is difficult in the differential diagnosis from aspergillosis

Rinshō shinkeigaku = Clinical neurology
Asako UenoMasaru Kuriyama

Abstract

A 59-year-old man with a long history of under-treated diabetes mellitus presented with severe inflammation that had spread from the sinus to the left orbital cavity. The bilateral internal carotid arteries were severely stenotic, causing multiple infarctions in the brain parenchyma. There was no β-D-glucan detected in the cerebrospinal fluid. Based on the presence of central nervous system (CNS) inflammation and vascular involvements that spread from the sinusitis, we tentatively diagnosed this patient as having invasive fungal CNS infection, i.e. zygomycosis or aspergillosis. Although the patient was treated with anti-fungal drugs such as liposomal amphotericin B and voriconazole, he died of respiratory failure. Pathological examination of the autopsied tissues demonstrated zygomycosis in the brain and heart. The prevalence of zygomycosis is generally very low (-5% of CNS infections) compared with that of other fungal infections. The lack of an appropriate diagnostic marker may lead to the under- or mis-diagnosis of zygomycosis. Moreover, it is hard to differentiate zygomycosis from aspergillosis because the two diseases share common clinical features such as the association of sinusitis and vascular involvement. The clinical...Continue Reading

References

Aug 5, 2005·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Maureen M RodenThomas J Walsh
Jun 20, 2007·Mycoses·Sandeep MohindraSunil Kumar Gupta
Jan 8, 2008·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Thomas J WalshUNKNOWN Infectious Diseases Society of America
May 10, 2008·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Jose A Vazquez
May 14, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Brad SpellbergAshraf S Ibrahim
Oct 16, 2009·Rinshō shinkeigaku = Clinical neurology·Asako UenoMasaru Kuriyama

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Citations

Sep 29, 2020·Infection and Drug Resistance·Yuka Kawaji-KanayamaJunya Kuroda

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