Mucormycosis Caused by Apophysomyces elegans-A Case Report and Systematic Review of the Literature of Rhino-Orbito-Cerebral Cases of the Genus Apophysomyces.

Abstract

Introduction: Orbitocerebral mucormycosis, caused by Apophysomyces, is a rare infection, usually occurring in tropical and subtropical climates, with a high mortality rate. We report a case of orbitocerebral mucormycosis caused by A. elegans in a person living with HIV (PLWHIV) from Africa alongside a systematic literature review updating current diagnostic and treatment strategies for orbitocerebral mucormycosis caused by Apophysomyces.

Methods: The presented case was treated in our hospital for polytrauma following a motor vehicle accident (MVA) with aggressive surgical debridement and therapy with liposomal Amphotericin B (AMB). We evaluated clinical presentation, imaging, surgery, and postoperative outcomes. A systematic review of English or German language articles (published between 1985 and 2025) was performed according to PRISMA guidelines. Articles describing patients with mucormycosis due to Apophysomyces were summarized. Quantitative values for relevant parameters that indicated a reduction in mortality and morbidity were obtained.

Results: The systematic search initially identified 452 publications, from which 79 studies were retrieved. Seventeen publications comprising 21 cases were included, along with one additional case from our institution, for a total of 22 rhino-orbito-cerebral infections caused by the genus Apophysomyces. Apophysomyces elegans (A. elegans) was the most frequently isolated species (n = 17), followed by A. variabilis (n = 4) and A. ossiformis (n = 1); A. trapeziformis was not reported. The majority of patients were male (72.7%), with a mean age of 40.7 ± 15.9 years. Trauma (27.3%) and diabetes mellitus (18.2%) were the most common underlying risk factors, with SARS-CoV-2 infection identified in 13.6% of cases.

Conclusion: Mucormycosis due to Apophysomyces is a rare but potentially devastating condition. Based on our experience and the literature, we suggest that the early diagnosis of Apophysomyces treated with liposomal AMB and aggressive surgical debridement is essential to reduce morbidity and mortality.