Disseminated mucormycosis caused by Absidia corymbifera leading to cerebral vasculitis

An 18-year-old woman was admitted to hospital because of subcutaneous hemat oma and fever of unknown origin. Acute myeloid leukemia was diagnosed and e mpirical antimicrobial treatment and induction chemotherapy were started. A fter initial defervescence, fever relapsed 2 days after the onset of neutro penia. The CT scan of the lung was consistent with an invasive fungal infec tion. Treatment with amphotericin B was started and antimicrobial treatment was continued with liposomal amphotericin B because of an increase in crea tinine later. The fever persisted and the patient suddenly developed progre ssive neurological symptoms. CT scan of the head suggested cerebral infarct ion and angiography of the extra- and intracranial arteries showed signs of vasculitis. Six days after the onset of neurological symptoms cerebral dea th was diagnosed. Autopsy revealed non-septate, irregularly branched hyphae in various histologic sections including brain. Absidia corymbifera could be isolated from lung tissue confirming the diagnosis of disseminated mucor mycosis. In this case, angiographic findings suggested severe cerebral vasc ulitis which was in fact caused by thromboembolic dissemination of fungal h yphae. This case underlines the fact that cerebral symptoms in febrile neut ropenic patients are highly indicative for fungal infections of the brain.