Angioinvasive mucormycosis and paradoxical stroke: a case report

Roxana Mititelu; Samuel Bourassa-Blanchette; Karan Sharma; Virginia Roth

doi:10.1099/jmmcr.0.005048

Volume 3, Issue 4

Case Report

Open Access

Angioinvasive mucormycosis and paradoxical stroke: a case report

Roxana Mititelu¹, Samuel Bourassa-Blanchette², Karan Sharma³ and Virginia Roth³
View Affiliations Hide Affiliations

Affiliations: ¹ McGill University, Montreal, Quebec, Canada ² Department of Internal medicine, The Ottawa Hospital, Ottawa, Ontario, Canada ³ Department of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada
Correspondence Samuel Bourassa-Blanchette [email protected]
Published: 11 July 2016 https://doi.org/10.1099/jmmcr.0.005048

Abstract

Introduction:

Rhizopus typically results in acute, aggressive and angioinvasive infection, particularly in immunosuppressed individuals. Risk factors include immunosuppression in haematologic malignancy, uncontrolled hyperglycemia, iron overload states, and older chelator agents such as deferoxamine.

Case Presentation:

We describe a case of a 33-year-old female with transfusion-dependent beta thalassemia who was started on intravenous deferiprone therapy and subsequently presented with a retropharyngeal abscess. Despite intravenous broad spectrum antibiotics, she continued to deteriorate and developed aphasia. A CT scan of her head showed multiple hypodensities. Blood cultures grew Rhizopus species and a subsequent transesophageal echocardiogram showed a mass in the right atrium with a patent foramen ovale.

Conclusion:

Although deferiprone, a newer iron chelator agent, has antifungal properties in vivo, this case illustrates that angioinvasive Rhizopus infections can occur in patients treated with deferiprone.

Received: 03/02/2016
Accepted: 14/05/2016
Published Online: 11/07/2016

Keyword(s): antifungal , aphasia , infectious endocarditis , iron chelator , Mucormycosis , PFO and stroke

This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

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References

Boelaert J. R., de Locht M., Van Cutsem J., Kerrels V., Cantinieaux B., Verdonck A., Van Landuyt H. W., Schneider Y. J. 1993; Mucormycosis during deferoxamine therapy is a siderophore-mediated infection. In vitro and in vivo animal studies. J Clin Invest 91:1979–1986 [View Article][PubMed]
[Google Scholar]
Brittenham G. M., Griffith P. M., Nienhuis A. W., McLaren C. E., Young N. S., Tucker E. E., Allen C. J., Farrell D. E., Harris J. W. 1994; Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med 331:567–573 [View Article][PubMed]
[Google Scholar]
Caes F. L., Van Belleghem Y. V., Missault L. H., Coenye K. E., Van Nooten G. J. 1995; Surgical treatment of impending paradoxical embolism through patent foramen ovale. Ann Thorac Surg 59:1559–1561[PubMed] [CrossRef]
[Google Scholar]
Falk V., Walther T., Krankenberg H., Mohr F. W. 1997; Trapped thrombus in a patent foramen ovale. Turk Kardiyol Dern Ars 45:90–92
[Google Scholar]
Jackman J. D., Simonsen R. L. 1992; The clinical manifestations of cardiac mucormycosis. CHEST Journal 101:1733–1736 [CrossRef]
[Google Scholar]
Kontoghiorghes G. J. 1995; Comparative efficacy and toxicity of desferrioxamine, deferiprone and other iron and aluminium chelating drugs. Toxicol Lett 80:1–18 [View Article][PubMed]
[Google Scholar]
Meacham R. R., Headley A. S., Bronze M. S., Lewis J. B., Rester M. M. 1998; Impending paradoxical embolism. Arch Intern Med 158:438–448[PubMed] [CrossRef]
[Google Scholar]
Myers P. O., Bounameaux H., Panos A., Lerch R., Kalangos A. 2010; Impending paradoxical embolism: systematic review of prognostic factors and treatment. CHEST Journal 137:164–170 [CrossRef]
[Google Scholar]
Piga A., Roggero S., Vinciguerra T., Sacchetti L., Gallo V., Longo F. 2005; Deferiprone: New insight. Ann N Y Acad Sci 1054:169–174 [View Article][PubMed]
[Google Scholar]
Roden M. M., Zaoutis T. E., Buchanan W. L., Knudsen T. A., Sarkisova T. A., Schaufele R. L., Sein M., Sein T., Chiou C. C. et al. 2005; Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 41:634–653 [View Article][PubMed]
[Google Scholar]
Spellberg B., Ibrahim A. S., Chin-Hong P. V., Kontoyiannis D. P., Morris M. I., Perfect J. R., Fredricks D., Brass E. P. 2012; The Deferasirox-AmBisome Therapy for Mucormycosis (DEFEAT Mucor) study: a randomized, double-blinded, placebo-controlled trial. J Antimicrob Chemother 67:715–722 [View Article][PubMed]
[Google Scholar]
Van Cutsem J., Boelaert J. R. 1989; Effects of deferoxamine, feroxamine and iron on experimental mucormycosis (zygomycosis). Kidney Int 36:1061–1068[PubMed] [CrossRef]
[Google Scholar]
Virmani R., Connor D. H., McAllister H. A. 1982; Cardiac mucormycosis. A report of five patients and review of 14 previously reported cases. Am J Clin Pathol 78:42–47[PubMed] [CrossRef]
[Google Scholar]

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Angioinvasive mucormycosis and paradoxical stroke: a case report

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Volume 3, Issue 4

Case Report

Open Access

Angioinvasive mucormycosis and paradoxical stroke: a case report

Abstract

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