CTICasesAngio-Invasive Mucormycosis in a Neutropenic Patient
Imaging findings
Chest radiograph in a neutropenic patient shows a subtle new opacity at the right lower lobe that is nearly imperceptible and does not clearly obscure the right heart border. CT demonstrates a peripheral area of consolidation in the right lower lobe. CT-guided core biopsy retrieved tissue that failed to grow organisms in culture but showed fungal elements on histopathology consistent with angio-invasive fungal infection, thought to be mucor. The lesion developed very rapidly over days on serial imaging, consistent with the aggressive nature of mucormycosis rather than the more indolent aspergillosis.
Key takeaways
Mucormycosis (zygomycosis) in severely neutropenic oncology patients can produce a peripheral nodule or consolidation indistinguishable from aspergillosis on CT and may not be recoverable on BAL cultures. CT-guided biopsy with histopathologic assessment of fungal elements and hyphal morphology is often necessary to confirm the diagnosis and distinguish mucor (broad aseptate hyphae branching at 90 degrees) from aspergillus. The rapid pace of lesion development over just a few days is characteristic of mucormycosis. Early diagnosis is critical because management may differ between mucor and aspergillus infections.
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