Halvorson Tracy S, Isaacson Alexandra L, Ford Bradley A, Firchau Dennis J
Acad Forensic Pathol. 2020 Jun;10(2):72-80. doi: 10.1177/1925362120960918. Epub 2020 Nov 25.
Mucormycosis is a rare and severe invasive fungal infection caused by ubiquitous fungi of the order Mucorales. Infection often occurs in immunocompromised hosts and includes cutaneous, pulmonary, gastrointestinal, rhinocerebral, and disseminated forms of disease. Although the clinical characteristics of mucormycosis are well established, infection can be difficult to diagnose antemortem, resulting in frequent postmortem diagnoses. Despite this, the gross appearance of mucormycosis at autopsy has not been well described. In the present report we illustrate the gross and histologic findings in four autopsy cases of mucormycosis, including one case of pulmonary disease and three cases of disseminated mucormycosis with cerebral, pulmonary, hepatic, renal, and gastrointestinal involvement. In all cases autopsy examination demonstrated characteristic hemorrhagic infarcts with a targetoid appearance in the affected organs. These findings are secondary to fungal angioinvasion with subsequent thrombosis and tissue necrosis. Mucormycosis should be suspected at autopsy when these characteristic infarcts are identified within the proper clinical context, and a high suspicion for atypical infections should be maintained postmortem in immunosuppressed patients.
毛霉病是一种由毛霉目无处不在的真菌引起的罕见且严重的侵袭性真菌感染。感染常发生在免疫功能低下的宿主中，包括皮肤、肺部、胃肠道、鼻脑和播散性疾病形式。尽管毛霉病的临床特征已得到充分认识，但生前感染可能难以诊断，导致尸检诊断频繁。尽管如此，毛霉病在尸检时的大体表现尚未得到充分描述。在本报告中，我们阐述了4例毛霉病尸检病例的大体和组织学发现，包括1例肺部疾病病例和3例累及脑、肺、肝、肾和胃肠道的播散性毛霉病病例。在所有病例中，尸检检查显示受影响器官出现具有靶样外观的特征性出血性梗死。这些发现继发于真菌血管侵袭，随后出现血栓形成和组织坏死。当在适当的临床背景下识别出这些特征性梗死时，尸检时应怀疑毛霉病，并且在免疫抑制患者死后应高度怀疑非典型感染。
