A Rare Case of Isolated Hepatic Mucormycosis in a Central Nervous System Lymphoma Patient Post-Stem Cell Transplant

Varun Vasudevan

Subject: A Rare Case of Isolated Hepatic Mucormycosis in a Central Nervous System Lymphoma Patient Post-Stem Cell Transplant

Mucormycosis is an aggressive fungal infection predominantly affecting immunocompromised individuals, notably those with diabetes mellitus, hematologic malignancies, or following solid organ and stem cell transplantation. Common manifestations include rhino-orbito-cerebral and pulmonary forms, while hepatic involvement is rare and typically associated with disseminated disease. We present a unique case of isolated hepatic mucormycosis manifesting as a solitary thick-walled liver abscess without systemic dissemination.

A 50-year-old woman with a history of diffuse large B-cell CNS lymphoma and type 2 diabetes mellitus underwent autologous peripheral blood stem cell transplantation 3 months earlier. She presented with right hypochondriac pain, cough, nausea, and anorexia. Laboratory tests showed leukocytosis and elevated inflammatory markers. Imaging revealed a 5.8-cm peripherally enhancing lesion in the caudate lobe of the liver, suggestive of an abscess, with no other organ involvement in the PET-CT.

Given her immunocompromised status and atypical presentation, prompt surgical intervention was undertaken. Robotic-assisted abscess drainage and excision were performed. Histopathological examination revealed broad, aseptate fungal hyphae consistent with mucormycosis; however, fungal cultures remained negative. The patient was initiated on liposomal amphotericin B and isavuconazole, leading to significant clinical improvement.

Diagnosing hepatic mucormycosis is challenging due to its rarity and nonspecific presentation. Culture negativity is common, making histopathological confirmation crucial. Most reported cases describe multiple hepatic lesions; solitary lesions, as in our case, are exceedingly rare. Early surgical intervention combined with antifungal therapy was pivotal in achieving a favorable outcome.

This case underscores the importance of maintaining a high index of suspicion for mucormycosis in immunocompromised patients presenting with atypical liver lesions. Timely diagnosis and intervention are essential to improve prognosis in such rare presentations ([Fig. 1]).

Fig. 1 MRI showing a thick-walled peripherally enhancing lesion in the caudate lobe of the liver.

Conflict of Interest

None declared.

Publication History

Received: 11 March 2025

Accepted: 24 March 2025

Article published online:
22 April 2025