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Open Access Highly Accessed Case Report

Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient

Véronique Hofman12, Abdelmajid Dhouibi1, Catherine Butori1, Bernard Padovani3, Martine Gari-Toussaint4, Dea Garcia-Hermoso5, Michèle Baumann6, Nicolas Vénissac7, Gieri Cathomas6 and Paul Hofman12*

Author affiliations

1 Laboratory of Clinical and Experimental Pathology, Louis Pasteur Hospital, 30 avenue de la voie romaine, Nice, 06002, France

2 Human Biobank, Louis Pasteur Hospital, 30 avenue de la voie romaine, Nice, 06002, France

3 Department of Radiology, Louis Pasteur Hospital, 30 avenue de la voie romaine, Nice, 06002, France

4 Laboratory of Mycology, Archet II Hospital, 151 route Saint-Antoine de Ginestière, Nice, 06200, France

5 Centre National de Référence Mycologie et Antifongiques (CNRMA); CNRS URA3012, Molecular Mycology Unit, Pasteur Institute, 25 rue du Docteur Roux, Paris, 75015, France

6 Laboratory for Molecular and Infectious Disease Pathology, Cantonal Institute for Pathology, Mühlemattstrasse 11, Liestal, 4410, Switzerland

7 Department of Thoracic Surgery, Louis Pasteur Hospital, 30 avenue de la voie romaine, Nice, 06002, France

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Citation and License

Diagnostic Pathology 2010, 5:1  doi:10.1186/1746-1596-5-1

Published: 8 January 2010

Abstract

Immunocompromised patients who develop invasive filamentous mycotic infections can be efficiently treated if rapid identification of the causative fungus is obtained. We report a case of fatal necrotic pneumonia caused by combined pulmonary invasive mucormycosis and aspergillosis in a 66 year-old renal transplant recipient. Aspergillus was first identified during the course of the disease by cytological examination and culture (A. fumigatus) of bronchoalveolar fluid. Hyphae of Mucorales (Rhizopus microsporus) were subsequently identified by culture of a tissue specimen taken from the left inferior pulmonary lobe, which was surgically resected two days before the patient died. Histological analysis of the lung parenchyma showed the association of two different filamentous mycoses for which the morphological features were evocative of aspergillosis and mucormycosis. However, the definitive identification of the associative infection was made by polymerase chain reaction (PCR) performed on deparaffinized tissue sections using specific primers for aspergillosis and mucormycosis. This case demonstrates that discrepancies between histological, cytological and mycological analyses can occur in cases of combined mycotic infection. In this regard, it shows that PCR on selected paraffin blocks is a very powerful method for making or confirming the association of different filamentous mycoses and that this method should be made available to pathology laboratories.