The reversed halo sign as the initial radiographic sign of pulmonary zygomycosis

Infection. 2012 Feb;40(1):77-80. doi: 10.1007/s15010-011-0156-y. Epub 2011 Jul 7.

Abstract

Zygomycosis is an emerging fungal infection that is associated with high mortality in hematological patients and stem cell transplantation (SCT) recipients. Radiology--computed tomography (CT) imaging in particular--facilitates the detection of lung involvement at an early stage of the infection. The reversed halo sign (RHS) has previously been reported in cryptogenetic organizing pneumonia and, more recently, as a manifestation of pulmonary zygomycosis. Here we describe a case of histologically proven zygomycosis due to Rhizopus microsporus in a SCT recipient. A chest CT scan performed on day +6 due to persistent fever unresponsive to antibiotics revealed the presence of the RHS, i.e., a focal ground-glass opacity mass surrounded by a solid ring of consolidation. The patient was treated with a combination of liposomal amphotericin B, caspofungin, and deferasirox, but subsequently developed a large pneumothorax and died on day +49 due to progressive infection. This case supports earlier observations that RHS may be an early radiological sign of zygomycosis, facilitating an aggressive diagnostic strategy.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Benzoates / therapeutic use
  • Caspofungin
  • Deferasirox
  • Echinocandins / therapeutic use
  • Fatal Outcome
  • Female
  • Humans
  • Iron Chelating Agents / therapeutic use
  • Lipopeptides
  • Lung / diagnostic imaging
  • Lung / microbiology*
  • Lung / pathology
  • Lung Diseases, Fungal / diagnostic imaging*
  • Lung Diseases, Fungal / microbiology
  • Lung Diseases, Fungal / pathology
  • Middle Aged
  • Mucormycosis / diagnostic imaging*
  • Mucormycosis / microbiology
  • Mucormycosis / pathology
  • Rhizopus / drug effects
  • Rhizopus / isolation & purification
  • Stem Cell Transplantation / adverse effects
  • Tomography, X-Ray Computed
  • Triazoles / therapeutic use

Substances

  • Antifungal Agents
  • Benzoates
  • Echinocandins
  • Iron Chelating Agents
  • Lipopeptides
  • Triazoles
  • liposomal amphotericin B
  • Amphotericin B
  • Caspofungin
  • Deferasirox