Spondylodiscitis associated with skin lesions caused by Rhizopus in a patient with systemic lupus erythematosus

• Published in: Le infezioni in medicina Vol. 30; no. 1; pp. 134 - 138
• Main Authors: de Saboya, Larissa Silva, Borges, Moara Alves Santa Bárbara, Camargo, Diego Gonçalves, de Paula Carneiro Cysneiros, Maria Auxiliadora, Oliveira, Murilo Eugênio, Guilarde, Adriana Oliveira
• Format: Journal Article
• Language: English
• Published: InfezMed 01-03-2022
• Subjects: Case Report
• ISSN: 1124-9390; 2532-8689
• DOI: 10.53854/liim-3001-17

Mucormycosis is a serious and rare fungal disease caused by opportunistic fungi of the zygomycete class, order
Mucorales
. The main clinical presentations are rhinocerebral, pulmonary, cutaneous, gastrointestinal, and disseminated infections. There are few reports in the literature of spondylodiscitis caused by mucormycosis. We report a 53-year-old male patient presenting with subcutaneous nodules and severe low back pain radiating to the lower limbs. The patient had systemic lupus erythematosus (SLE) for 8 years and corticoid-induced diabetes. He had been using 60 mg/day of prednisone in the last year, with a recent pulse therapy regimen with methylprednisolone and cyclophosphamide to control the renal dysfunction. Nuclear magnetic resonance (NMR) of the spine showed spondylodiscitis. The patient underwent spinal arthrodesis and lesion biopsy. The histopathological study of the vertebra reported a necro suppurative inflammation with numerous fungal structures described as a wide range of hyaline hyphae. The histopathology of the cutaneous nodule exhibited an extensive suppurative lesion centered on the subcutaneous tissue, associated with a large amount of hyphae, similar to that found in the spinal lesion, suggestive of mucormycosis. The fungal culture showed the growth of
Rhizopus spp.
Treatment was performed with amphotericin B lipid complex 5 mg/kg/day for 60 days. After antifungal treatment, there was a progressive reduction in the number of subcutaneous nodules and total improvement of the patient’s low back pain, with recovery of his gait. At the 18-month outpatient visit follow-up, the patient was stable and without recurrence. In our case, timely diagnosis enabled the removal of the osteoarticular focus and the targeted therapy resulted in a satisfactory clinical response, without sequelae or complications, despite the patient’s underlying immunosuppressed status.