ABSTRACT
Antecedentes. Las mucormicosis son infecciones poco frecuentes en pacientes inmunocompetentes, y se han descrito muy pocos casos de mucormicosis asociadas a aspergilosis en pacientes no hematológicos. Caso clínico. Un varón de 17 años, inmunocompetente y sin factores de riesgo previamente conocidos, ingresó en el hospital tras presentar crisis convulsivas 11 días después de sufrir un accidente de moto. Presentó un curso clínico tórpido por infección fúngica invasiva mixta, con afectación pulmonar por Aspergillus niger y mucormicosis diseminada por Rhizomucor pusillus (diagnóstico histopatológico y microbiológico en varios lugares no contiguos). Fue tratado con anfotericina B liposomal durante 7 semanas (dosis total acumulada > 10 g) y precisó múltiples reintervenciones quirúrgicas. El paciente sobrevivió y fue dado de alta de UCI tras 5 meses de evolución y múltiples complicaciones. Conclusiones. El tratamiento con anfotericina B liposomal y el manejo quirúrgico agresivo consiguió la erradicación de la infección fúngica invasiva mixta, pero alertamos de la necesidad de mantener un mayor grado de sospecha clínica y de realizar técnicas de diagnóstico precoz de infecciones fúngicas invasivas en pacientes no inmunodeprimidos para evitar la diseminación de la enfermedad y el mal pronóstico asociado (AU)
Background. Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. Case report. 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 (AU)
Subject(s)
Humans , Male , Young Adult , Rhizomucor/isolation & purification , Rhizomucor/pathogenicity , Aspergillus niger , Aspergillus niger/isolation & purification , Aspergillus niger/pathogenicity , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/microbiology , Amphotericin B/therapeutic use , Infections/surgery , Infections/drug therapy , Rhizomucor , Biopsy/methods , Infection Control/methods , Pulmonary Aspergillosis/microbiology , Risk Factors , Rhinitis/complications , Rhinitis/microbiology , Necrosis/complications , Microbiological TechniquesABSTRACT
BACKGROUND: Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT: 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.
Subject(s)
Aspergillosis/complications , Aspergillus niger/isolation & purification , Craniocerebral Trauma/complications , Immunocompetence , Mucormycosis/complications , Rhizomucor/isolation & purification , Wound Infection/microbiology , Accidents, Traffic , Adolescent , Akinetic Mutism/etiology , Amphotericin B/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/microbiology , Coinfection/drug therapy , Coinfection/microbiology , Combined Modality Therapy , Craniocerebral Trauma/surgery , Critical Care/methods , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/surgery , Humans , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Lung Diseases, Fungal/surgery , Male , Mucormycosis/drug therapy , Mucormycosis/microbiology , Postoperative Complications/microbiology , Skull Fractures/etiology , Skull Fractures/surgery , Ulcer/etiology , Ulcer/surgerySubject(s)
Vertebral Artery Dissection/complications , Adolescent , Adult , Angiography , Female , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Risk Factors , Rupture, Spontaneous , Treatment Outcome , Vertebral Artery/diagnostic imaging , Vertebral Artery/pathology , Vertebral Artery Dissection/diagnosis , Vertebral Artery Dissection/drug therapyABSTRACT
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