History and Physical Examination

Symptoms of mucormycosis vary depending on the involved anatomic site. However, unexplained or persistent fever in a patient who has immunosuppression and who is receiving broad-spectrum antibiotics should alert the clinician to look for possible foci of mucormycosis.

Rhinocerebral disease

The most common signs and symptoms of rhinocerebral mucormycosis are altered mental status, fever, and pain and swelling over the involved site. Severe headache can also manifest. Most of these findings occur in patients with diabetic ketoacidosis.

A black eschar of the nasal mucosa or palate is usually a hallmark sign of rhinocerebral mucormycosis. It is a sign of deep infection and tissue destruction of the nasal mucosa. This finding on physical examination should prompt biopsy and empiric treatment.

CNS disease

Persistence of altered mental status after metabolic abnormalities are corrected, especially in patients with diabetic ketoacidosis, should alert the physician to consider mucormycosis involving the central nervous system (CNS).

Loss of extraocular muscular function, along with proptosis and cranial nerve dysfunction of cranial nerves V and VII, are signs of neurologic involvement in mucormycosis. Several other cranial nerves, such as cranial nerves I, III, and IV, can also be involved.

Pulmonary and GI disease

Fever, dyspnea, hemoptysis, and cough are observed in patients with pulmonary mucormycosis.

Abdominal pain can be a manifestation of gastrointestinal (GI) mucormycosis. GI mucormycosis is mostly encountered in premature neonates and in patients with malnutrition. Severe malnutrition is an independent risk factor.

Cutaneous disease

A black eschar on the skin of a patient who is immunocompromised should prompt skin biopsy, as seen in the following image. Progressive cellulitis of skin lesions with gangrene and necrosis is another concern in cutaneous mucormycosis.

Black eschar on the skin of an immunocompromised patient.

View Media Gallery

Differential Diagnoses

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Media Gallery

Black eschar on the skin of an immunocompromised patient.
Mucormycosis with broad, aseptate hyphae (hematoxylin and eosin, original magnification ×40).
Angioinvasion (hematoxylin and eosin, original magnification ×10).
Perineural invasion (hematoxylin and eosin, original magnification ×20).

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Author

Meera Varman, MD Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer, Sanofi<br/>Received research grant from: Merck; MedImmune; Regenron; Pfizer;Novartis; Sanof; GSK<br/>Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Mary Carmen Y Mancao, MD, Christine A Reyes, MD, and Debra Whaley, MD, to the development and writing of the source article.