Mucormycosis in a Patient With AIDS Receiving Systemic Steroids
Andrew Pan, Latha Srinath
The Journal of the American Osteopathic Association
M ucormycosis is a potentially fatal opportunistic infection caused by the fungi belonging to the order Mucorales. These fungi are ubiquitous in nature, release airborne spores, and cause necrosis by invading blood vessels. Infection is rare; although humans come in contact with Mucorales, an intact innate immune system is sufficient to prevent infection. Rees et al 1 reported an incidence of 1.7 mucormycosis infections for every 1 million individuals from 1992 to 1993 in 3 California counties.
... In a review of 929 mucormycosis cases that occurred between 1940 and 2003, Roden et al 2 reported that the mortality of mucormycosis ranged from 10% to 98%, depending on areas of the body involved. 2 Diabetes was the most common risk factor (found in 36% of cases), followed by hematologic malignancies (17% of cases) and solid organ or hematopoietic cell transplantation (12% of cases). 2 Early treatment is important; a study 3 of 70 patients with mucormycosis revealed that starting amphotericin B more than 6 days after diagnosis resulted in an almost 2-fold increase in mortality at 12 weeks after diagnosis compared with early treatment (83% vs 49%). In the current report, we present an unusual case of mucormycosis in a patient with AIDS who was receiving steroids. Mucormycosis is an opportunistic fungal infection with a high mortality rate. Although mucormycosis is relatively rare, recent studies suggest that the incidence is on the rise as a result of increased use of chemotherapy and steroids. The authors present an unusual case of invasive mucormycosis in a hospitalized patient with AIDS who was receiving short-term, high-dose steroids and who had associated steroid-induced diabetes. The patient was otherwise healthy, with no underlying risk factors such as neutropenia or intravenous drug use. The patient developed acute onset of proptosis, vision loss, and invasive Mucor in the left maxillary sinus that extended along the optic nerve intracranially. Despite aggressive treatment, the patient died. Physicians should be aware of steroid-induced diabetes as a risk factor for invasive fungal infections such as mucormycosis.