Cerebral Mucormycosis Associated with Intravenous Drug Use: Three Case Reports and Review

Abstract

We describe three cases of cerebral mucormycosis in intravenous drug users and review 22 previously reported cases. Involvement of the basal ganglia was demonstrated in all but two cases. Seven of the 10 patients tested for antibodies to the human immunodeficiency virus (HIV) were seronegative. Eight of the 25 patients survived and were discharged from the hospital; for 7 of 10 patients, cultures of brain lesions yielded Rhizopus arrhizus. The radiographic findings varied, and in most cases, no or minimal contrast enhancement was seen in the initial computed tomography scans. Although uncommon, the diagnosis of cerebral mucormycosis should be considered when basal ganglia lesions are present in an intravenous drug user, regardless of previous exposure to HIV.

Cerebellar Mucormycosis in a Young Man: A Case Report

“…The involvement of basal ganglia of the brain is more common when the source of the infection is spreading through hematogenous transmission (3,7,8). Our patient is one of the very rare cases in which the infection was presented in hemispheres of cerebellum without the involvement of the skull.…”

Pearls & Oy-sters: Isolated cerebral zygomycosis in an intravenous drug user

“…The vast majority of IVDA-related cases have involvement of the basal ganglia. 1,6 Contrast CT can show a wide range of enhancement patterns and there are only a few cases reported with MRI. As our case also demonstrated, an important feature is that unilateral basal ganglia mass lesions with low attenuation rapidly become bilateral and more extensive, 6 highlighting the need for rapid diagnosis and treatment.…”

Clinical Reasoning:A 28-year-old IV drug user with bilateral basal ganglia and brainstem lesions

“…Including our case described here, only 35 biopsy-or autopsy-proven cases in immunocompetent individuals have been reported in the Western literature since 1970. [3][4][5][6][7][8][9][10] Most patients were young with a mean age of 31 years (range 21-53 years). Sixty-three percent of the reported cases were men and 37% were women.…”

“…5 In terms of treatment, IV amphotericin B was the only therapy that consistently provided survival benefit. [3][4][5][6][7][8][9][10] The disease was uniformly fatal if not treated with amphotericin B. The survival rate increased to 61% with prompt diagnosis and initiation of treatment.…”