Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): towards different entities

Clémentine de La Porte; Corentin Provost; Anne Coste; Raoul Herbrecht; Blandine Denis; Emmanuel Canet; Florence Ader; Lucie Lelièvre; Nathalie Pansu; Stéphanie Haouy; Louise Chantelot; Taieb Chouaki; Juliette Lambert; Benjamin Verillaud; Thorsten Braun; Claire Tantet; Karine Risso; Pierre Tattevin; Fanny Vuotto; Jean-Marie Michot; Valérie Pourcher; Marie-Elisabeth Bougnoux; Valérie Letscher-Bru; Alexandre Alanio; Florent Morio; Florence Persat; Sophie Cassaing; Nathalie Bourgeois; Laurence Lachaud; Lilia Hasseine; Françoise Botterel; Laurence Delhaes; Sébastien Imbert; Julie Bonhomme; Jean-Pierre Gangneux; Romain Sonneville; Laurence Millon; Michel Wolff; Francois Danion; Olivier Paccoud; Olivier Lortholary; Olivier Naggara; Fanny Lanternier; Alexandra Serris

doi:10.1093/mmy/myaf122

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Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): towards different entities

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Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): towards different entities

Clémentine de La Porte, Corentin Provost, Anne Coste, Raoul Herbrecht, Blandine Denis, Emmanuel Canet, Florence Ader, Lucie Lelièvre, Nathalie Pansu, Stéphanie Haouy, …

Medical mycology (Oxford)

23/12/2025

DOI: https://doi.org/10.1093/mmy/myaf122

PMID: 41432290

Résumé

diagnosis

immunocompromised

mucormycosis

presentations

central nervous system

Central nervous system mucormycosis (CNS-M) is a severe disease with difficult and often delayed diagnosis, leading to high mortality. The aim of this new study was to assess clinical and radiological presentation according to underlying conditions and dissemination routes, to optimize diagnostic strategies. We conducted a retrospective national study including 54 CNS-M cases diagnosed between 2005 and 2020, with brain imaging reviewed by two neuroradiologists. CNS-M resulted from presumed hematogenous dissemination in 29 patients (54%) and from direct extension in 25 (46%), known as rhino-orbito-cerebral mucormycosis (ROCM). No neurological symptoms were found in 10/54 (19%), regardless of dissemination route. Hematogenous CNS-M mainly affected highly immunocompromised (HM or SOT) patients (90%), including 43% neutropenic. Radiology showed abscesses (87%) and small vessel disease (39%). In ROCM, two patterns emerged depending on osteolysis (19/25, 76%) or its absence (6/25, 24%). ROCM without bone lysis, mostly in severely immunosuppressed patients, caused meningitis without abscess, whereas osteolytic ROCM led to abscess formation (11/18, 60%). Without osteolysis, perineural spread along the optic nerve occurred in 2/3 cases. Serum Mucorales PCR was positive in 91% of hematogenous and 64% of ROCM cases. Fungal co-infections occurred in 26%. This study underscores distinct invasion patterns and the need for extensive workup in CNS-M, highlighting the diagnostic value of MRI with gadolinium and serum Mucorales qPCR based on dissemination route and underlying condition. MRI is particularly useful in ROCM for detecting meningitis (80%), large vessel disease (30%), and perineural involvement (8%).

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Titre: Multicenter Analysis of General presentations and Imaging features in Cerebral MUCORmycosis (MAGICMUCOR): towards different entities
Créateurs - sans rôle: Clémentine de La Porte - Department of Infectious Diseases, Necker University Hospital (AP-HP), 149 rue de Sèvres, 75015, Paris, France
Corentin Provost - Department of Radiology, Sainte-Anne University Hospital, 2 ter rue d'Alésia, 75014, Paris, France
Anne Coste - Department of Infectious Diseases, Brest University Hospital, 2 av. Foch, 29200, Brest, France
Raoul Herbrecht - Department of Haematology, Strasbourg Cancer Institute, 17 rue Albert Calmette, 67200, Strasbourg, France
Blandine Denis - Department of Infectious Diseases, Saint-Louis University Hospital (AP-HP), 1 av. Claude Vellefaux, 75010, Paris, France
Emmanuel Canet - Intensive Care Unit, Nantes University Hospital, 2 all. De l'Ïle Gloriette, 44000, Nantes, France
Florence Ader - Department of Infectious and tropical Diseases, Croix-Rousse University Hospital, 103 Gd Rue de la Croix-Rousse, 69004, Lyon, France
Lucie Lelièvre - Department of Internal Medicine, Toulouse University Hospital, 2 rue Charles Viguerie, 31300, Toulouse, France
Nathalie Pansu - Department of Infectious Diseases, Montpellier University Hospital, 191 av. du Doyen Gaston Giraud, 34295, Montpellier, France
Stéphanie Haouy - Department of Haematology, Montpellier University Hospital, 191 av. du Doyen Gaston Giraud, 34295, Montpellier, France
Louise Chantelot - Intensive Care Unit, Bichat Claude-Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France
Taieb Chouaki - Department of Mycology, Amiens University Hospital, 1 rue du Pr. Christian Cabrol, 80000, Amiens, France
Juliette Lambert - Department of Infectious Diseases, André Mignot Hospital Center, 177 rue de Versailles, 78150, Le Chesnay, France
Benjamin Verillaud - Department of ENT, Lariboisière University Hospital, 2 rue Ambroise Paré, 75010, Paris, France
Thorsten Braun - Department of Haematology, Avicenne University Hospital, 125 rue de Stalingrad, 93000, Bobigny, France
Claire Tantet - Department of Infectious Diseases, Avicenne University Hospital, 125 rue de Stalingrad, 93000, Bobigny, France
Karine Risso - Department of Internal Medicine, Nice University Hospital, 4 all. De la Reine, 06000, Nice, France
Pierre Tattevin - Department of Infectious Diseases and Intensive Care Unit, Rennes University Hospital, 2 rue Henri le Guilloux, Rennes, France
Fanny Vuotto - Department of Infectious Diseases, Lille University Hospital, 2 av. Oscar Lambret, 59000, Lille, France
Jean-Marie Michot - Department of Haematology, Gustave Roussy Cancer Institute, 114 rue Edouard Vaillant, 94805, Villejuif, France
Valérie Pourcher - Department of Infectious Diseases, La Pitié Salpétrière University Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
Marie-Elisabeth Bougnoux - Department of Mycology, Necker University Hospital (AP-HP), 149 rue de Sèvres, 75015, Paris, France
Valérie Letscher-Bru - Department of Mycology, Strasbourg University Hospital, 1 Pl. de l'Hôpital, 67000, Strasbourg, France
Alexandre Alanio - Department of Mycology, Saint-Louis University Hospital (AP-HP), 1 av. Claude Vellefaux, 75010, Paris, France
Florent Morio - Nantes Université, CHU Nantes, Cibles et Médicaments des Infections et de l'Immunité, IICiMed, UR 1155, F-44000, 2 all. De l'Ïle Gloriette, 44000, Nantes, France
Florence Persat - Department of Mycology, Croix-Rousse University Hospital, 103 Gd Rue de la Croix-Rousse, 69004, Lyon, France
Sophie Cassaing - Department of Mycology, Toulouse University Hospital, 2 rue Charles Viguerie, 31300, Toulouse, France
Nathalie Bourgeois - Department of Mycology, Montpellier University Hospital, 191 av. du Doyen Gaston Giraud, 34295, Montpellier, France
Laurence Lachaud - Department of Mycology, Montpellier University Hospital, 191 av. du Doyen Gaston Giraud, 34295, Montpellier, France
Lilia Hasseine - Department of Mycology, Nice University Hospital, 4 all. De la Reine, 06000, Nice, France
Françoise Botterel - Department of Mycology, Henri Mondor University Hospital, 1 rue Gustave Eiffel, 94000, Créteil, France
Laurence Delhaes - Department of Mycology, Bordeaux University Hospital, Pl. Amélie Raba Léon, 33000, Bordeaux, France
Sébastien Imbert - Department of Mycology, Bordeaux University Hospital, Pl. Amélie Raba Léon, 33000, Bordeaux, France
Julie Bonhomme - Department of Mycology, Caen University Hospital, ToxEMAC-ABTE, Université de Normandie Unicaen, AV. de la Côte de Nacre, 14000, Caen, France
Jean-Pierre Gangneux - Department of Mycology, Rennes University Hospital, 2 rue Henri le Guilloux, Rennes, France
Romain Sonneville - Intensive Care Unit, Bichat Claude-Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France
Laurence Millon - Department of Parasitology Mycology, Besançon University Hospital, UMR CNRS 6249, 3 Bd. Alexandre Fleming, 25030, Besançon, France
Michel Wolff - Department of Neurology, Sainte-Anne University Hospital, 2 ter rue d'Alésia, 75014, Paris, France
Francois Danion - Department of Infectious Diseases, Strasbourg University Hospital, 1 Pl. de l'Hôpital, 67000, Strasbourg, France
Olivier Paccoud - Paris Cité University, 45 rue des Saints-Pères, 75006, Paris, France
Olivier Lortholary - National Reference Center of invasive fungal infections, Pasteur Institute of Paris, France
Olivier Naggara - Department of Radiology, Sainte-Anne University Hospital, 2 ter rue d'Alésia, 75014, Paris, France
Fanny Lanternier - National Reference Center of invasive fungal infections, Pasteur Institute of Paris, France
Alexandra Serris - Paris Cité University, 45 rue des Saints-Pères, 75006, Paris, France
Détails de publication: Medical mycology (Oxford)
Identifiants: 99147930009311
Unité académique: Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle - MIVEGEC
Langue: English
Type de ressource: Journal article