Isolated Cerebral Mucormycosis in Immunocompetent Adults who Inject Drugs: Case Reports and Systematic Review of the Literature

Author:

Meyerowitz Eric A1,Sanchez Sarimer1,Mansour Michael K12,Triant Virginia A1234,Goldberg Marcia B125ORCID

Affiliation:

1. Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA

2. Harvard Medical School, Boston, Massachusetts, USA

3. Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA

4. Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA

5. Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA

Abstract

Abstract Background Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe 2 cases of isolated cerebral mucormycosis in immunocompetent adults and describe this syndrome in detail in the context of a systemic literature review. Methods Using the criteria (1) isolated cerebral disease, (2) mucormycosis (by polymerase chain reaction, culture, or pathology), and (3) affected an immunocompetent individual, we identified 53 additional cases from 1969 to 2020. Results Of these 55 cases, ~60% occurred in men, >70% were in patients under age 35, 92% were associated with intravenous drug use, and >85% had infection centered in the basal ganglia. Many presented with cranial nerve deficits, headache, focal weakness, or altered mental status. Conclusions No patient survived without amphotericin, and steroid administration was associated with worse outcomes. Given the current opioid crisis, this syndrome may be seen more frequently.

Funder

Massachusetts General Hospital

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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