This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liang, K. P. Articles by Temesgen, Z. Search for Related Content PubMed PubMed Citation Articles by Liang, K. P. Articles by Temesgen, Z.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, March 2006, p. 892-898, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.892-898.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Rhino-Orbitocerebral Mucormycosis Caused by Apophysomyces elegans

Kimberly P. Liang,^1* Imad M. Tleyjeh,¹ Walter R. Wilson,¹ Glenn D. Roberts,² and Zelalem Temesgen¹

Department of Medicine and Division of Infectious Diseases,¹ Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota²

Received 3 September 2005/ Returned for modification 20 October 2005/ Accepted 21 December 2005

Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin B and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. Diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin B. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. Survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy.

---

* Corresponding author. Mailing address: Mayo Clinic, 200 First St. SW, Rochester, MN 55905. Phone: (507) 284-4474. Fax: (507) 284-0564. E-mail: liang.kimberly{at}mayo.edu.

---

Journal of Clinical Microbiology, March 2006, p. 892-898, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.892-898.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

This article has been cited by other articles:

• Alvarez, E., Sutton, D. A., Cano, J., Fothergill, A. W., Stchigel, A., Rinaldi, M. G., Guarro, J. (2009). Spectrum of Zygomycete Species Identified in Clinically Significant Specimens in the United States. J. Clin. Microbiol. 47: 1650-1656 [Abstract] [Full Text]  
• Ferguson, T. D., Schniederjan, S. D., Dionne-Odom, J., Brandt, M. E., Rinaldi, M. G., Nolte, F. S., Langston, A., Zimmer, S. M. (2007). Posaconazole Treatment for Apophysomyces elegans Rhino-Orbital Zygomycosis following Trauma for a Male with Well-Controlled Diabetes. J. Clin. Microbiol. 45: 1648-1651 [Abstract] [Full Text]