LAUSR

A 54-year-old man was admitted to the intensive care unit (ICU) with a coma requiring mechanical ventilation (day 1). The Glasgow coma score was 3 and there was no meningeal syndrome. A single inflammatory and necrotic skin lesion on the right thigh was noticed (Fig. 1a). Twelve days earlier, the patient had received autologous haematopoietic stem cell transplantation following immunochemotherapy for a cerebral relapse of primary central nervous system lymphoma. Broad-spectrum antibacterial treatments and caspofungin followed by voriconazole were given during neutropenic fever. On day 1, brain magnetic resonance imaging found multiple supraand infra-tentorial lesions with predominant involvement of the right parietal lobe (Fig. 1b). Concurrently, thoraco-abdominal computed tomography scan found a single round-shaped lesion in the left upper lung and multiple hypodensities suggestive of infarction involving the liver, the spleen and the kidneys (Fig. 1). Transoesophageal echocardiography ruled out endocarditis. Biopsy of the skin lesion found arteriolar angioinvasive mycosis (Fig. 1a). Liposomal amphotericin B was started on day 2. Cerebrospinal fluid and blood cultures obtained in the ICU remained sterile. Fulminant progression with worsening cerebral oedema and multiple organ failure led to death in the ICU on day 7. An autopsy confirmed the disseminated necrotic lesions with abscesses and vascular occlusions by fungal hyphae (Fig. 1). Skin-lesion cultures grew Rhizomucor spp.