Disseminated mucormycosis: An unusual case of ascites with bone marrow invasion

Chowdhury Adnan Sami; Hasan Mostafa Rashed; Abed Hussain Khan; Lovely Barai; Shohael Mahmud Arafat

doi:10.1016/j.idcr.2022.e01553

Disseminated mucormycosis: An unusual case of ascites with bone marrow invasion

IDCases. 2022 Jul 4:29:e01553. doi: 10.1016/j.idcr.2022.e01553. eCollection 2022.

Authors

Chowdhury Adnan Sami¹, Hasan Mostafa Rashed¹, Abed Hussain Khan¹, Lovely Barai², Shohael Mahmud Arafat¹

Affiliations

¹ Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
² Department of Microbiology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine, and Metabolic Disorders, Dhaka, Bangladesh.

Abstract

Mucormycosis is a fatal invasive illness most frequently seen in immunocompromised hosts with uncontrolled diabetes, hematological malignancies, organ transplantation, or long-term steroid treatment. It has a poorer outcome than other fungal diseases due to its rapid spread and resistance to antifungal agents. We report a rare case of disseminated mucormycosis including the bone marrow, peritoneum, lung, and lymph nodes in an apparently immunocompetent 58-year-old gentleman who presented with two months of ascites and weight loss. After a thorough analysis, we found aseptate fungal hyphae in the bone marrow and ascitic fluid. In addition, a cottony white, woolly growth indicative of mucor species was seen in the ascitic fluid culture. CT scans of the chest and abdomen indicate characteristics consistent with mucor invasion. We began the patient on tablet posaconazole, but he died on the fifth day. The atypical presentation in an apparently immunocompetent patient and broad dissemination with rare bone marrow involvement emphasizes the disease's invasiveness.

Keywords: Bone marrow; Dissemination; Mucormycosis; Peritonitis; Zygomycosis.

Publication types

Case Reports