Mucormycosis Leading to Cerebral Edema and Cerebellar Tonsillar Herniation after Allogeneic Bone Marrow Transplant: A Case Report

Abstract

Introduction Mucormycosis following hematopoietic stem cell transplant (HSCT) carries a very high mortality rate. Pulmonary mucormycosis often leads to systemic dissemination and eventual death. It is imperative for transplant providers to have a high level of suspicion for mucormycosis and initiate early treatment. Here, we present a 64-year-old woman who died of disseminated mucormycosis 13 days following her allogeneic HSCT. Case Presentation A 64-year-old female with a history of acute myeloid leukemia (AML) presented for allogeneic HSCT and passed away from intracerebral hemorrhage secondary to mucormycosis infection 13 days following her transplant. On autopsy, it was found she had angioinvasive mucormycosis in her frontal lobe leading to cerebral edema which eventually led to tonsillar herniation and brainstem infarction. Her lungs were the likely source of infectious dissemination. Discussion This case represents an unusual course of events following HSCT in that no other published case shows tonsillar herniation resulting from mucormycosis-related intracerebral swelling. We also report this case because it is believed mucormycosis in HSCT patients is underreported. Additionally, our case highlights the importance of increased vigilance for mucormycosis in patients with prolonged neutropenia prior to HSCT and the potential link of voriconazole prophylaxis and increased risk for mucormycosis.

Mucormycosis and Covid-19 Pandemic: An Additional Challenge

“…2 Mucormycosis is an uncommon infection by Mucorales, with a severe invasive course in people with hematological malignancy, solid organ or stem cell transplant, and diabetes mellitus. [2][3][4][5][6][7] This opportunistic infection has an angioinvasive property causing tissue necrosis and thrombosis; and species of the Rhizopus, Mucor, and Lichtheimia (Absidia) genera are more often involved. 3 Pulmonary mucormycosis due to the inhalation of spores can cause pneumonia with lung necrosis and cavity, and may spread to mediastinum and heart or to distant sites by hematogenous route.…”

“…3 Pulmonary mucormycosis due to the inhalation of spores can cause pneumonia with lung necrosis and cavity, and may spread to mediastinum and heart or to distant sites by hematogenous route. [2][3][4][5][6][7] Jeurkar et al reported a 64-year-old woman with an acute myeloid leukemia [AML] and allogeneic transplant who had angioinvasive mucormycosis and central nervous system infarction. 4 Pulmonary infection was the most probable primary source of the severe disseminated condition.…”

“…[2][3][4][5][6][7] Jeurkar et al reported a 64-year-old woman with an acute myeloid leukemia [AML] and allogeneic transplant who had angioinvasive mucormycosis and central nervous system infarction. 4 Pulmonary infection was the most probable primary source of the severe disseminated condition. The authors stressed the exceeding unusual occurrence of mucormycosis-related intracerebral swelling, and possibility of unsuspected or underreported mucormycosis in transplanted patients.…”

“…The authors stressed the exceeding unusual occurrence of mucormycosis-related intracerebral swelling, and possibility of unsuspected or underreported mucormycosis in transplanted patients. 4 Qi et al reviewed clinical data, treatment, and prognosis of 7 patients with diagnosis of mucormycosis; 4 were males, and median age was 36 (19-79) years. 5 Predisposing conditions were AML (2), acute B lymphoblastic leukemia, T-cell lymphoma, chronic myelocytic leukemia in blastic phase, myeloproliferative neoplasm, and severe aplastic anemia after the transplantation.…”