Mucormycosis is an angioinvasive fungal infection caused by fungi of the order Mucorales, most commonly presenting as rhino-orbito-cerebral and pulmonary disease. We report the case of J.R.P., a 69-year-old man with type 2 diabetes, hypertension, smoking history, and rural work, referred to urology for evaluation of gross hematuria. Investigation with ultrasonography and CT urography revealed an expansive lesion in the right renal pelvis suggestive of urothelial neoplasia, leading to radical right nephroureterectomy. However, histopathological analysis of the surgical specimen unexpectedly revealed invasive mucormycosis with extensive tissue necrosis and evident fungal angioinvasion. Systemic staging with chest CT demonstrated nodular lesions in the right middle and lower lobes compatible with fungal abscesses, and exclusive clinical treatment was chosen. Otolaryngologic evaluation with CT and nasofibroscopy ruled out rhinosinus involvement. The patient was treated with liposomal amphotericin B for 21 days followed by maintenance therapy with isavuconazole, with excellent clinical evolution and complete symptom resolution. Mucormycosis is classically associated with immunosuppression states such as decompensated diabetes mellitus. Isolated renal involvement is rare and usually occurs in the context of disseminated disease, which has high mortality. This report of disseminated mucormycosis with primary urologic presentation highlights the importance of investigating multiple sites for correct disease staging, even in cases with apparently localized initial manifestations.
Primo et al. (Sun,) studied this question.