Clinical challenge: fatal mucormycotic osteomyelitis caused by Rhizopus microsporus despite aggressive multimodal treatment

BMC Infectious Diseases

Mareike Verbeek²  Ingo Ringshausen²  Rüdiger von Eisenhart-Rothe¹  Christian Peschel²  Andreas Toepfer¹  Peter M Prodinger¹  Ulrich Lenze¹  Matthias Hauschild¹  Ingo J Banke¹  Norbert Harrasser¹ 

[1] Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;III. Department of Internal Medicine Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany

关键词: Radical surgical proximal femoral resection;    Immunocompromitation;    Fungal osteomyelitis;    Rhizopus microsporus;    Mucormycosis;   

Others  :  1127181
DOI  :  10.1186/1471-2334-14-488

 received in 2014-05-21, accepted in 2014-09-03,  发布年份 2014

【 摘 要 】

Background

Mucormycosis is an invasive mycotic disease caused by fungi in the zygomycetes class. Although ubiquitous in the environment, zygomycetes are rarely known to cause invasive disease in immunocompromised hosts with a high mortality even under aggressive antifungal and surgical therapy. Clinically, mucormycosis frequently affects the sinus occasionally showing pulmonary or cerebral involvement. However skeletal manifestation with Rhizopus microsporus (RM) osteomyelitis leading to emergency surgical proximal femoral resection with fatal outcome has not been described yet.

Case presentation

We report the case of a 73-year-old male suffering from myelodysplastic syndrome with precedent bone marrow transplantation. Six months after transplantation he consulted our internal medicine department in a septic condition with a four week history of painful swelling of the right hip. Radiography, computed tomography and magnetic resonance imaging revealed multiple bone infarcts in both femurs. In the right femoral head, neck and trochanteric region a recent infarct showed massive secondary osteomyelitis, breaking through the medial cortex. Emergency surgical proximal femoral resection was performed due to extensive bone and soft tissue destruction. Microbiological and basic local alignment search tool (BLAST) analysis revealed RM. Amphotericin B and posaconazole treatment with septic revision surgery was performed. However the disease ran a rapid course and was fatal two months after hospital admission.

Conclusion

This alarming result with extensive RM osteomyelitis in the proximal femur of an immunocompromised patient may hopefully warn medical staff to perform early imaging and aggressive surgical supported multimodal treatment in similar cases.

【 授权许可】

   
2014 Harrasser et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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