SHM Converge Scientific Abstract ePoster Gallery-Apophysomyces Elegans Mucormycosis in a Young Immunocompetent Patient

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This case report describes a 41-year-old immunocompetent man from Arizona who developed severe orbital and facial mucormycosis caused by <strong>Apophysomyces elegans</strong> after extensive yard work. He presented with 3 days of right orbital swelling, fever, chills, tinnitus, and decreased sensation in the right V2 distribution. Initial workup showed preseptal cellulitis on CT, but subsequent surgery and pathology confirmed invasive fungal disease with necrotic tissue, non-septate hyphae, angioinvasion, and osteomyelitis of the orbital and skull structures. Cultures grew <strong>A. elegans</strong> along with additional organisms.

The infection required aggressive management, including ethmoidectomy, right orbitotomy with enucleation, skull lesion resection/reconstruction, and repair of a CSF leak. He was treated with <strong>liposomal amphotericin B</strong> and <strong>posaconazole</strong>, plus meropenem for bacterial co-infection. Despite treatment, he developed complications including acute kidney injury from amphotericin B and contrast exposure, punctate brain infarcts likely from fungal spread, and recurrent infection requiring rehospitalization and repeat surgery.

The presentation emphasizes that <strong>mucormycosis can occur in patients without classic risk factors</strong>. Although diabetes, hematologic malignancy, transplant, and corticosteroid exposure are common predisposing conditions, a significant minority of cases occur in otherwise healthy patients. <strong>Apophysomyces elegans</strong> is notable for infecting immunocompetent hosts, especially in endemic regions such as the southern United States, including Arizona.

Key lessons include maintaining a high index of suspicion for mucormycosis in patients with relevant environmental exposure, pursuing early diagnosis, and initiating prompt surgical and antifungal treatment to improve outcomes. The report also notes the broader global rise in mucormycosis during the COVID-19 era, potentially linked to increased corticosteroid use.

Asset Subtitle

Joseph W. Budenske

Meta Tag

Author List Evan Brickner, Joao Paulo Albuquerque Ferreira, Joseph W. Budenske, Rajesh Kotagiri, Tirdad Zangeneh

Category Clinical Vignettes

Concept Mucormycosis

Concept Immunocompromised State

Concept Apophysomyces elegans

Concept Orbital Swelling

Concept Facial Swelling

Distinguished Non-Finalist

Presenter Organization University of Arizona College of Medicine Tucson

Presenting Author Joseph W. Budenske

Track Adult

Keywords

mucormycosis

Apophysomyces elegans

orbital infection

immunocompetent host

Arizona

liposomal amphotericin B

posaconazole

angioinvasion

osteomyelitis

surgical debridement

Mucormycosis

Immunocompromised State

Apophysomyces elegans

Orbital Swelling

Facial Swelling