Fatal mucormycosis and aspergillosis coinfection associated with haemophagocytic lymphohistiocytosis: A case report and literature review

J Mycol Med. 2023 Mar;33(1):101325. doi: 10.1016/j.mycmed.2022.101325. Epub 2022 Aug 8.

Abstract

Invasive mould infections are life-threatening and mainly occur in immunocompromised patients. Whereas aspergillosis is described during haemophagocytic lymphohistiocytosis (HLH), only a few cases of concomitant mucormycosis with HLH have been reported. Here, we present an uncommon coinfection of mucormycosis and aspergillosis associated with HLH probably due to a varicella zoster virus (VZV) viraemia which was unresponsive to triple antifungal therapy (liposomal amphotericin B combined with isavuconazole and caspofungin). A review of the cases of mucormycosis with HLH showed that this uncommon association was always lethal and underscored the relevance of screening for mould infections in patients with HLH.

Keywords: Aspergillosis; Haemophagocytic lymphohistiocytosis; Invasive fungal infection; Mucormycosis; Varicella zoster virus.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillosis* / complications
  • Aspergillosis* / diagnosis
  • Aspergillosis* / drug therapy
  • Coinfection* / complications
  • Coinfection* / diagnosis
  • Coinfection* / drug therapy
  • Fungi
  • Humans
  • Lymphohistiocytosis, Hemophagocytic* / complications
  • Lymphohistiocytosis, Hemophagocytic* / diagnosis
  • Lymphohistiocytosis, Hemophagocytic* / drug therapy
  • Mucormycosis* / complications
  • Mucormycosis* / diagnosis
  • Mucormycosis* / drug therapy

Substances

  • Antifungal Agents