, Volume 178, Issue 1–2, pp 111–115 | Cite as

Pulmonary Mucormycosis due to Lichtheimia ramosa in a Patient with HIV Infection

  • Murat KutluEmail author
  • Çağrı Ergin
  • Ferda Bir
  • Süleyha Hilmioğlu-Polat
  • Ramazan Gümral
  • Ceyda Necan
  • Ali Koçyiğit
  • Selda Sayın-Kutlu


Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm3. The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi’s sarcoma or severe immunodeficiency, as in our case.


HIV infection Pulmonary mucormycosis Lichtheimia ramosa 


Conflict of interest

The authors report no conflict of interests.


  1. 1.
    Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53.PubMedCrossRefGoogle Scholar
  2. 2.
    Skiada A, Pagano L, Groll A, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011;17:1859–67.PubMedCrossRefGoogle Scholar
  3. 3.
    Ribes JA, Vanover-Sams CA, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev. 2000;13:236–301.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Roilides E, Kontoyiannis DP, Walsh TJ. Host defenses against zygomycetes. Clin Infect Dis. 2012;54(Suppl 1):S61–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012;54(Suppl 1):S23–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Antinori S, Nebuloni M, Magni C, et al. Trends in the postmortem diagnosis of opportunistic invasive fungal infections in patients with AIDS: a retrospective study of 1,630 autopsies performed between 1984 and 2002. Am J Clin Pathol. 2009;132:221–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Bitar D, Van Cauteren D, Lanternier F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997–2006. Emerg Infect Dis. 2009;15:1395–401.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Van den Saffele JK, Boelaert JR. Zygomycosis in HIV-positive patients: a review of the literature. Mycoses. 1996;39:77–84.PubMedCrossRefGoogle Scholar
  9. 9.
    Petrikkos G, Drogari-Apiranthitou M. Zygomycosis in immunocompromised non-haematological patients. Mediterr J Hematol Infect Dis. 2011;3:e2011012.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Alastruey-Izquierdo A, Hoffmann K, de Hoog GS, et al. Species recognition and clinical relevance of the zygomycetous genus Lichtheimia (syn. Absidia pro parte, Mycocladus). J Clin Microbiol. 2010;48:2154–70.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Turin L, Riva F, Galbiati G, Cainelli T. Fast, simple and highly sensitive double-rounded polymerase chain reaction assay to detect medically relevant fungi in dermatological specimens. Eur J Clin Invest. 2000;30:511–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Hall TA. BioEdit: a user-friendly biological sequence alignment editor and analysis program for Windows 95/98 NT. Nucl Acids Symp Ser. 1999;41:95–8.Google Scholar
  13. 13.
    Levy E, Bia MJ. Isolated renal mucormycosis: case report and review. J Am Soc Nephrol. 1995;5:2014–9.PubMedGoogle Scholar
  14. 14.
    Blázquez R, Pinedo A, Cosín J, Miralles P, Lacruz C, Bouza E. Nonsurgical cure of isolated cerebral mucormycosis in an intravenous drug user. Eur J Clin Microbiol Infect Dis. 1996;15:598–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Keogh CF, Brown JA, Phillips P, Cooperberg PL. Renal mucormycosis in an AIDS patient: imaging features and pathologic correlation. AJR Am J Roentgenol. 2003;180:1278–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Righi E, Giacomazzi CG, Bassetti M, et al. Soft-tissue infection with Absidia corymbifera and kidney complications in an AIDS patient. Med Mycol. 2007;45:637–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Abril V, Ortega E, Segarra P, Pedro F, Sabater V, Herrera A. Rhinocerebral mucormycosis in a patient with AIDS: a complication of diabetic ketoacidosis following pentamidine therapy. Clin Infect Dis. 1996;23:845–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Boumis E, Chinello P, Conte A, et al. Rhino-orbital zygomycosis secondary to diabetic ketoacidosis in an HIV-positive patient: case report and literature review. AIDS. 2006;20:136–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Bongiovanni M, Ranieri R, Ferrari D, Codecà C, Tartaro T, Uziel L. Prolonged survival of an HIV-infected subject with severe lymphoproliferative disease and rhinocerebral mucormycosis. J Antimicrob Chemother. 2007;60:192–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Merchant S, Reichman R, Koval CE. Rhinocerebral zygomycosis in an HIV-infected man during therapy with an investigational CCR5 inhibitor. AIDS. 2007;21:1666–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Fujii T, Takata N, Katsutani S, Kimura A. Disseminated mucormycosis in an acquired immunodeficiency syndrome (AIDS) patient. Intern Med. 2003;42:129–30.PubMedCrossRefGoogle Scholar
  22. 22.
    Chavanet P, Lefranc T, Bonnin A, Waldner A, Portier H. Unusual cause of pharyngeal ulcerations in AIDS. Lancet. 1990;336:383–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Nagy-Agren SE, Chu P, Smith GJ, Waskin HA, Altice FL. Zygomycosis (mucormycosis) and HIV infection: report of three cases and review. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;10:441–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Parra-Ruiz J, Peña-Monje A, Tomas-Jimenez C, Antelo-Lorenzo R, Escobar-Lara T, Hernández-Quero J. Septic arthritis due to Absidia corymbifera in a patient with HIV-1 infection. Infection. 2008;36:279–81.PubMedCrossRefGoogle Scholar
  25. 25.
    Artis WM, Fountain JA, Delcher HK, Jones HE. A mechanism of susceptibility to mucormycosis in diabetic ketoacidosis: transferrin and iron availability. Diabetes. 1982;31:1109–14.PubMedCrossRefGoogle Scholar
  26. 26.
    Ibrahim AS, Spellberg B, Edwards J Jr. Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Curr Opin Infect Dis. 2008;21:620–5.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Smith AG, Bustamante CI, Gilmor GD. Zygomycosis (absidiomycosis) in an AIDS patient. Absidiomycosis in AIDS. Mycopathologia. 1989;105:7–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Lee BL, Holland GN, Glasgow BJ. Chiasmal infarction and sudden blindness caused by mucormycosis in AIDS and diabetes mellitus. Am J Ophthalmol. 1996;122:895–6.PubMedGoogle Scholar
  29. 29.
    Pedro-de-Lelis FJ, Sabater-Marco V, Herrera-Ballester A. Necrotizing maxillary sinus mucormycosis related to candidiasis and microsporidiosis in an AIDS patient. AIDS. 1995;9:1386–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Virally ML, Riveline JP, Virally J, et al. Pulmonary mucormycosis in a diabetic patient with HIV. Diabetes Care. 2002;25:2105.PubMedCrossRefGoogle Scholar
  31. 31.
    Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J Jr, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009;48:1743–51.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Alastruey-Izquierdo A, Cuesta I, Walther G, Cuenca-Estrella M, Rodriguez-Tudela JL. Antifungal susceptibility profile of human-pathogenic species of Lichtheimia. Antimicrob Agents Chemother. 2010;54:3058–60.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Vitale RG, de Hoog GS, Schwarz P, et al. Antifungal susceptibility and phylogeny of opportunistic members of the order mucorales. J Clin Microbiol. 2012;50:66–75.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Murat Kutlu
    • 1
    Email author
  • Çağrı Ergin
    • 2
  • Ferda Bir
    • 3
  • Süleyha Hilmioğlu-Polat
    • 4
  • Ramazan Gümral
    • 5
  • Ceyda Necan
    • 1
  • Ali Koçyiğit
    • 6
  • Selda Sayın-Kutlu
    • 1
  1. 1.Department of Infectious Diseases and Clinical Microbiology, Faculty of MedicinePamukkale UniversityDenizliTurkey
  2. 2.Department of Medical Microbiology, Faculty of MedicinePamukkale UniversityDenizliTurkey
  3. 3.Department of Medical Pathology, Faculty of MedicinePamukkale UniversityDenizliTurkey
  4. 4.Department of Medical Microbiology, Faculty of MedicineEge UniversityIzmirTurkey
  5. 5.Department of Medical MicrobiologyGulhane Military Medical AcademyAnkaraTurkey
  6. 6.Department of Radiology, Faculty of MedicinePamukkale UniversityDenizliTurkey

Personalised recommendations