Fulminant myocarditis and pulmonary cavity lesion induced by disseminated mucormycosis in a chronic hemodialysis patient: Report of an autopsied case
Author(s) -
Fujisawa Yuhei,
Hara Satoshi,
Zoshima Takeshi,
Maekawa Naoto,
Inoue Dai,
Sasaki Motoko,
Gamou Tadatsugu,
Nagata Yoji,
Hayashi Kenshi,
Takeji Akari,
Ito Kiyoaki,
Mizushima Ichiro,
Fujii Hiroshi,
Kawano Mitsuhiro
Publication year - 2020
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/pin.12943
Subject(s) - medicine , fulminant , mucormycosis , autopsy , myocarditis , amiodarone , pathology , lung , hemodialysis , lesion , surgery , atrial fibrillation
Mucormycosis is a rare fungal infection occurring in the immunocompromised host. It is difficult to diagnose, and its cardiac involvement is extremely rare. Here, we report a 64‐year‐old Japanese man with a 5‐year history of hemodialysis with disseminated mucormycosis causing fulminant myocarditis and pulmonary necrosis under glucocorticoid use. Two months before, he had received an implantable cardioverter defibrillator and started to take amiodarone for recurrent ventricular arrhythmias due to hypertensive cardiomyopathy. He developed amiodarone‐induced interstitial pneumonia and then received glucocorticoid therapy. Although the interstitial pneumonia partially improved, a lung cavitary lesion developed in the upper right lobe. Antibiotics had no effect, and serologic tests, blood and sputum cultures and bronchoalveolar lavage fluid were all negative for infectious pathogens. Eventually, he died of fulminant myocarditis. Autopsy revealed disseminated mucormycosis with vascular invasion and fungal thrombi, hemorrhage and infarction in lung (cavity lesion), heart (severe myocarditis), brain, thyroid and subcutaneous tissue around the implantable cardioverter defibrillator. The lung cavitary lesion was the only clinical finding suggestive of mucormycosis before autopsy. When an immunocompromised patient shows a progressive lung cavity lesion, the possibility of mucormycosis should be considered so that a broad‐spectrum antifungal agent can be empirically administered in a timely fashion.