Pulmonary Mucormycosis in a BMT patient, mistaken for Invasive Aspergillosis

Case number: 

13

Summary: 

A 44 year old man with myelodysplastic syndrome in transformation received an HLA mismatched allogeneic BMT in November 1999. Bone marrow recovery was poor and he remained pancytopenic. He also developed acute and then chronic graft versus host disease and veno-occlusive disease of the liver. His course was also complicated by hyperglycaemia and CMV infection. Despite itraconazole prophylaxis, he developed a pulmonary infiltrate with a 'halo sign'. A percutaneous biopsy showed hyphae and he was treated with caspofungin. Three days later the culture revealed Mucorales and his treatment was changed to Abelcet. A lobectomy was done but renal failure supervened and he could not be weaned from the ventilator. He died some days later. Lobectomy cultures revealed Aspergillus niger, and no Mucorales, but histopathology was consistent with mucormycosis.

Species: 

  • Aspergillus niger