CTICasesAngioinvasive Fungal Infection (Rhizopus) in Neutropenic AML
Imaging findings
A patient with relapsed AML and pre-existing bronchiectasis developed a small effusion and a peripheral, round area of consolidation with a rim of higher peripheral attenuation, an infarct-like appearance, while neutropenic. Bronchoscopy grew Rhizopus species, and despite treatment the lesion did not improve over several studies, remaining a discrete round consolidative focus with surrounding ground-glass opacity confined to the left lower lobe, ultimately requiring a left lower lobectomy that confirmed angioinvasive fungal infection.
Key takeaways
A discrete, round, peripheral consolidative lesion with an infarct-like rim of higher attenuation in a neutropenic patient should raise concern for angioinvasive fungal infection such as mucormycosis (Rhizopus), which can be indolent and unresponsive to medical therapy alone, sometimes requiring surgical resection for source control and definitive diagnosis when imaging fails to improve despite antifungal treatment.
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