Correct!
5. Tissue biopsy from affected organ or skin

The gold standard for diagnosing mucormycosis is a tissue biopsy and histopathology revealing the characteristic ribbon-type morphology with 45 degree branching of fungal elements. 1,3-B’D glucan and galactomannan are negative in the case of mucormycosis, but rather are tests that one would consider obtaining for evaluation for aspergillosis. Both of these tests were negative or this patient, thus indicating a much less likelihood for aspergillosis and giving a clue for another disease process, in particular another invasive fungal process. Blood cultures for mucormycosis are invariable negative with poor sensitivities, likely due to the fact that the fungal walls can easily be disrupted, and often one would need to prepare the specimen with fine cuts rather than a process that breaks apart the integrity of the fungal wall.

Learning Points

• Early diagnosis and treatment of mucormycosis is one cornerstone to successfully managing this aggressive disease.
• Immunocompromised hosts are at the highest risk for mucormycosis, especially with solid organ transplant recipients and hematological malignancies with hematopoietic stem cell transplantation.
• One should consider mucormycosis in any immunocompromised host, especially if fungal infection is a concern.
• When mucormycosis has disseminated, this represents its angioinvasive form which typically results in hemorrhage, necrosis and infarctions. At this stage, it is invariably fatal.
• The diagnostic test of choice is to obtain a tissue biopsy.
• Treatment of choice is liposomal amphotericin B

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Reference

1. Hamdi T, Karthikeyan V, Alangaden GJ. Mucormycosis in a renal transplant recipient: case report and comprehensive review of literature. Int J Nephrol. 2014;2014:950643. [CrossRef] [PubMed]

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