Fungal myositis

Fungal myositis is a rare infectious condition in which fungal organisms directly invade skeletal muscle tissue, causing inflammation, pain, and destruction of muscle fibers. It is classified under infective myositis (ICD-10: M60.0) and may be caused by a variety of fungal pathogens, including Candida species, Aspergillus species, Cryptococcus, Histoplasma, and mucoraceous molds (agents of mucormycosis). The disease primarily affects the musculoskeletal system but can involve surrounding soft tissues and may disseminate to other organ systems. Fungal myositis predominantly occurs in immunocompromised individuals, including those with hematologic malignancies, organ transplant recipients on immunosuppressive therapy, patients with HIV/AIDS, individuals receiving prolonged corticosteroid treatment, and those with uncontrolled diabetes mellitus. Clinical features include localized or diffuse muscle pain (myalgia), swelling, tenderness, fever, and progressive muscle weakness. In some cases, abscess formation within the muscle may occur. The condition can be difficult to diagnose because symptoms may mimic other forms of myositis or soft tissue infection, and definitive diagnosis typically requires muscle biopsy with histopathological examination and fungal culture. Treatment of fungal myositis involves systemic antifungal therapy tailored to the specific causative organism. Commonly used agents include amphotericin B (particularly for invasive mold infections), azole antifungals such as voriconazole or fluconazole, and echinocandins. Surgical debridement of necrotic or abscess-containing tissue may be necessary, especially in cases caused by mucoraceous molds. Correction or reduction of underlying immunosuppression, when feasible, is an important component of management. Prognosis depends on the extent of infection, the causative organism, and the patient's immune status; disseminated fungal myositis carries significant morbidity and mortality.

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