Rapid Progression of Cunninghamella Species Leading to Respiratory Compromise

Cunninghamella spp are a group of filamentous fungi commonly found in soil and decaying matter and can cause infections in immunocompromised individuals, especially those undergoing chemotherapy or with hematologic malignancies. These infections can lead to a rapidly progressive and fatal outcome. Despite accounting for less than 10% of documented mucormycosis cases, disseminated Cunninghamella infections have a higher mortality rate when compared with other mucormycosis. We present the case of a patient with chronic myelogenous leukemia and myelodysplastic syndromes/myeloproliferative neoplasms overlap, receiving azacitidine, who initially presented with a diabetic foot ulcer infested with maggots. The patient rapidly developed respiratory distress and encephalopathy, with imaging revealing consolidation in the right upper lung lobe infected with Cunninghamella spp. Treatment with amphotericin B did not improve the patient's condition. Brain imaging also indicated a 24.4 × 16.9-mm lesion, and given the patient's comorbidities and disease progression, surgical intervention was not feasible. The patient was subsequently transitioned to comfort care.