Description

A 71-year-old man with newly diagnosed, untreated acute myeloid leukaemia presented with fever, cough and confusion. Complete blood count showed neutropenia (90 cells/mm³), lymphopenia (350 cells/mm³) and 90% circulating blast. Initial chest X-ray showed evidence of new right lower lobe infiltrates, which were absent on a chest X-ray 3 weeks ago (figure 1). A CT scan brain revealed multiple enhancing lesions in temporal and occipital area. An MRI performed later, confirmed the same lesion with restricted diffusion (figure 2). With a presentation of pulmonary and cerebral involvement in an immunocompromised host the differential for this presentation was broad. Bacterial causes such as Nocardia and possibly streptococcal and staphylococcal infections were considered. Fungal causes especially Aspergillus, Fusarium and Mucorales were also high on the differential. Blood cultures and cultures from the bronchial alveolar lavage were obtained and the patient was started on linezolid, meropenem and liposomal amphotericin B; however the patient died within the first 24 h. The initial staining of the bronchial alveolar lavage sample demonstrated hyphal elements and few days’ later growth was identified on the fungal culture and the organism was identified as Rhizomucor pusillus, an agent of mucormycosis. Cerebral involvement with mucormycosis has been previously reported and is related to contiguous infection or haematogenous dissemination from another organ, most likely lungs.1 This case highlights the importance of considering disseminated mucormycosis as a cause of pulmonary and cerebral involvement in patients with hematological malignancy.

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Figure 1

Chest X-ray demonstrating new right lower lobe infiltrates.

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Figure 2

MRI brain demonstrating enhancing lesions in temporal and occipital area.