Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): toward different entities

Central nervous system mucormycosis (CNS-M) is a severe disease with difficult and often delayed diagnosis, leading to high mortality. The aim of this new study was to assess clinical and radiological presentation according to underlying conditions and dissemination routes to optimize diagnostic strategies. We conducted a retrospective national study including 54 CNS-M cases diagnosed between 2005 and 2020, with brain imaging reviewed by two neuroradiologists. CNS-M resulted from presumed hematogenous dissemination in 29 patients (54%) and from direct extension in 25 (46%), known as rhino-orbito-cerebral mucormycosis (ROCM). No neurological symptoms were found in 10/54 (19%), regardless of dissemination route. Hematogenous CNS-M mainly affected highly immunocompromised (HM or SOT) patients (90%), including 43% neutropenic. Radiology showed abscesses (87%) and small-vessel disease (39%). In ROCM, two patterns emerged depending on osteolysis (19/25, 76%) or its absence (6/25, 24%). ROCM without bone lysis, mostly in severely immunosuppressed patients, caused meningitis without abscess, whereas osteolytic ROCM led to abscess formation (11/18, 60%). Without osteolysis, perineural spread along the optic nerve occurred in 2/3 cases. Serum Mucorales PCR was positive in 91% of hematogenous and 64% of ROCM cases. Fungal co-infections occurred in 26%. This study underscores distinct invasion patterns and the need for extensive workup in CNS-M, highlighting the diagnostic value of MRI with gadolinium and serum Mucorales qPCR based on dissemination route and underlying condition. MRI is particularly useful in ROCM for detecting meningitis (80%), large-vessel disease (30%), and perineural involvement (8%).

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Journal
Medical Mycology
Published
2025-12-23
DOI
https://doi.org/10.1093/mmy/myaf122
Primary Topic
Antifungal resistance and susceptibility
Type
article
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article

Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): toward different entities

Thorsten Braun, Benjamin Verillaud, Romain Sonneville, Sébastien Imbert et al.
Medical Mycology
Antifungal resistance and susceptibility
article

Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): toward different entities

Thorsten Braun, Benjamin Verillaud, Romain Sonneville, Sébastien Imbert, O. Naggara, Laurence Lachaud, Julie Bonhomme, Fanny Lanternier, Emmanuel Canet, F Morio, Stéphanie Haouy, S Cassaing, Laurence Millon, Karine Risso, Nathalie Pansu, Alexandre Alanio, Françoise Botterel, Taïeb Chouaki, Claire Tantet, Jean-Pierre Gangneux, François Danion, Anne Coste, Raoul Herbrecht, Lucie Lelièvre, Lilia Hasseine, Michel Wolff, Pierre Tattevin, Fanny Vuotto, Valérie Letscher‐Bru, Florence Ader, Jean-Marie Michot, Louise Chantelot, Laurence Delhaes, Clémentine de La Porte, Nathalie Bourgeois, Corentin Provost, Marie-Elisabeth Bougnoux, Blandine Denis, Florence Persat, Valérie Pourcher, Olivier Paccoud, Juliette Lambert, Olivier Lortholary, Alexandra Serris
article en

Abstract

Central nervous system mucormycosis (CNS-M) is a severe disease with difficult and often delayed diagnosis, leading to high mortality. The aim of this new study was to assess clinical and radiological presentation according to underlying conditions and dissemination routes to optimize diagnostic strategies. We conducted a retrospective national study including 54 CNS-M cases diagnosed between 2005 and 2020, with brain imaging reviewed by two neuroradiologists. CNS-M resulted from presumed hematogenous dissemination in 29 patients (54%) and from direct extension in 25 (46%), known as rhino-orbito-cerebral mucormycosis (ROCM). No neurological symptoms were found in 10/54 (19%), regardless of dissemination route. Hematogenous CNS-M mainly affected highly immunocompromised (HM or SOT) patients (90%), including 43% neutropenic. Radiology showed abscesses (87%) and small-vessel disease (39%). In ROCM, two patterns emerged depending on osteolysis (19/25, 76%) or its absence (6/25, 24%). ROCM without bone lysis, mostly in severely immunosuppressed patients, caused meningitis without abscess, whereas osteolytic ROCM led to abscess formation (11/18, 60%). Without osteolysis, perineural spread along the optic nerve occurred in 2/3 cases. Serum Mucorales PCR was positive in 91% of hematogenous and 64% of ROCM cases. Fungal co-infections occurred in 26%. This study underscores distinct invasion patterns and the need for extensive workup in CNS-M, highlighting the diagnostic value of MRI with gadolinium and serum Mucorales qPCR based on dissemination route and underlying condition. MRI is particularly useful in ROCM for detecting meningitis (80%), large-vessel disease (30%), and perineural involvement (8%).

Medical MycologyVol. 64(1)
Hôpital Necker-Enfants Malades (FR), Institut Pasteur (FR), Université de Montpellier (FR), Université Paris Cité (FR), Institut Gustave Roussy (FR), Centre Hospitalier Universitaire de Nice (FR), Université Rennes 2 (FR), Sorbonne Université (FR), Centre Hospitalier Universitaire de Besançon (FR), Hôpital de la Croix-Rousse (FR), Institut de Cancérologie Strasbourg (FR), Université Sorbonne Paris Nord (FR), Sorbonne Paris Cité (FR), Centre Hospitalier Universitaire de Montpellier (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Assistance Publique – Hôpitaux de Paris (FR), Bordeaux Population Health (FR), Hôpital Lariboisière (FR), Hôpital André Mignot (FR), Pitié-Salpêtrière Hospital (FR), Centre Hospitalier Sainte-Anne (FR), Centre d'Investigation Clinique de Nantes (FR), Hôpital Avicenne (FR), Hôpitaux Universitaires Henri-Mondor (FR), Centre Oscar Lambret (FR), Hôpital Lapeyronie (FR), Centre Hospitalier Régional Universitaire de Brest (FR), Hôpital Saint-Louis (FR), Hôpital Bichat-Claude-Bernard (FR), Hôpital Paule de Viguier (FR), Université Gustave Eiffel (FR), Hôpital Civil, Strasbourg (FR), Nantes Université (FR), Université de Caen Normandie (FR)
Good health and well-being
Openalex Percentile: Top 31%
Antifungal resistance and susceptibility
DOISourceOpenAlex
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