Abstract Details

Title Fatal Cerebral Complications in Disseminated Mucormycosis after Influenza-associated Pneumonia in an Immunocompromised Patient: An Autopsy Case Report

Topic Infectious Disease

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 10-006

Objective We aim to report the clinical characteristics and appropriate diagnostic approaches for a rare fatal case of cerebral complications in disseminated mucormycosis after influenza-associated pneumonia in an immunocompromised patient.

Background Disseminated mucormycosis is a severe fungal infection that primarily affects immunocompromised individuals and often results in tissue infarction and high mortality rates. Diagnosis and treatment are challenging because of poor blood culture sensitivity and lack of serological markers.

Design/Methods NA

Results A 75-year-old woman with uncontrolled diabetes, high-risk myelodysplastic syndrome (h-MDS), and IgG4-related disease, treated with long-term prednisolone, presented with fever and mild consciousness disturbance. On admission, she exhibited pancytopenia, elevated inflammatory markers, and a positive influenza A test. Chest CT showed influenza-associated pneumonia with organizing pneumonia. Despite treatment with cefepime, peramivir, and increased corticosteroids, her condition worsened, leading to left hemiplegia and severe consciousness disturbance on hospital day 3. Brain MRI on day 8 showed bilateral ischemic strokes, and contrast MRI on day 9 indicated progressive ischemic strokes, leptomeningitis, and vasculitis. CSF analysis revealed increased leukocyte count and elevated IL-6, but cultures and cytology were negative. Despite intensive care, she succumbed to extensive hemorrhagic cerebral infarction and midbrain herniation by day 13. Postmortem examination identified widespread fungal infection due to Rhizomucor miehei, along with pulmonary infarction and renal involvement. The final diagnosis was cerebral infarction with vasculitis and encephalomeningitis secondary to disseminated mucormycosis following influenza-associated pneumonia.

Conclusions This rare case underscores the need to consider opportunistic infections, such as mucormycosis, in immunocompromised patients exhibiting neurological symptoms post-influenza. Early identification and antifungal treatment are crucial for improving outcomes in similar cases. Advanced diagnostic techniques may enhance the detection and management of such infections.

Authors/Disclosures
Masashi Watanabe, MD (Ehime Prefectural Central Hospital) PRESENTER	Dr. Watanabe has nothing to disclose.
YOSHITO HOMMA, MD	Dr. HOMMA has nothing to disclose.
Satoshi Sumida, MD, PhD	Dr. Sumida has nothing to disclose.
AKIRA WATANABE, MD, PhD	Prof. WATANABE has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Asahi Kasei Pharma. Prof. WATANABE has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for MSD.
Ryuichiro Hiyama, MD	Dr. Hiyama has nothing to disclose.
Kyosuke Saeki, MD, PhD	Dr. Saeki has nothing to disclose.
浩一中瀬, MD, PhD	Dr. ?? has nothing to disclose.
Yoshiyasu Hiratsuka, MD, PhD	Dr. Hiratsuka has nothing to disclose.
Yoshihiro Ohtsuka, MD	Dr. Ohtsuka has nothing to disclose.
Akira Yoshida, MD	Dr. Yoshida has nothing to disclose.
Haruki Ohtsubo, MD	Dr. Ohtsubo has nothing to disclose.
Akira Shiraoka	Dr. Shiraoka has nothing to disclose.
Itaru Kyoraku, PhD	Dr. Kyoraku has nothing to disclose.
Kensho Okamoto, MD	Dr. Okamoto has nothing to disclose.

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