Disseminated Rhizomucor Miehei With Hemorrhagic Stroke

Disseminated mucormycosis is a rapidly progressive and often fatal infection in immunocompromised patients. We describe a 72-year-old man with acute myeloid leukemia and prolonged neutropenia who developed disseminated Mucorales infection during inpatient chemotherapy. He had concurrent Streptococcus mitis bacteremia, followed by a lung opacity with a reverse halo sign and a hemorrhagic infarct in the left middle cerebral artery territory, consistent with septic emboli from the lung. Plasma metagenomic testing detected Rhizomucor miehei without a biopsy, which was not possible because of severe thrombocytopenia. The result did not change antifungal therapy but helped the decision to move to comfort care, given the high mortality of the infection and the extent of brain injury. This case shows the value of noninvasive molecular testing in disseminated mucormycosis when tissue sampling cannot be done.