Skin and soft-tissue mucormycosis in patients receiving Bruton’s tyrosine kinase inhibitors: case report and literature review

Bruton’s tyrosine kinase inhibitors (BTKi) have been associated to an increased risk of invasive fungal disease, with skin and soft tissue (SST) mucormycosis accounting for a minority of cases. We present a 72-year-old patient with chronic lymphocytic leukemia who developed necrotizing fasciitis and myositis due to Lichtheimia spp after 4 months of therapy with the second generation BTKi zanubrutinib, with a fatal outcome despite aggressive treatment. Our literature review identified seven additional cases of BTKi-associated SST mucormycosis, revealing an all-cause mortality rate of 37.5%. Two thirds of the patients had a history of previous trauma or skin lesion.