{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:09:24Z","timestamp":1785427764053,"version":"3.56.0"},"reference-count":31,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["ASM Case Rep"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:sec>\n                      <jats:title>Background<\/jats:title>\n                      <jats:p>Bruton tyrosine kinase inhibitors (BTKIs) are increasingly utilized for patients with certain malignant hematologic conditions. While cases of invasive fungal infections have been reported in patients on BTKIs, no multi-center epidemiological studies have been performed. The Epic Cosmos platform, a nationwide electronic health record data set, provides an opportunity to assess real-world epidemiologic data.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                      <jats:title>Case Summary<\/jats:title>\n                      <jats:p>\n                        A 69-year-old female with recently diagnosed Waldenstr\u00f6m macroglobulinemia with associated autoimmune hemolytic anemia undergoing treatment with zanubrutinib and prednisone presented with fatigue and acute kidney injury. Imaging demonstrated a bladder mass with bilateral hydronephrosis leading to transurethral resection of the bladder mass with histopathology revealing both broad ribbon-like hyphae resembling Mucorales spp. and acute-angle branching resembling\n                        <jats:italic toggle=\"yes\">Aspergillus<\/jats:italic>\n                        spp. with angioinvasion. Additional imaging revealed bilateral pulmonary cavitary lesions and renal and brain involvement. Bronchoalveolar lavage returned a positive galactomannan and culture growth of\n                        <jats:italic toggle=\"yes\">Aspergillus fumigatus<\/jats:italic>\n                        . The patient was treated with liposomal amphotericin B with eventual transition to oral isavuconazole. Zanubrutinib and steroids were discontinued. To assess real-world occurrence of IFIs in patients on BTKIs, we performed an exploratory analysis using Epic Cosmos.\n                      <\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                      <jats:title>Conclusion<\/jats:title>\n                      <jats:p>IFIs continue to be described in patients undergoing treatment with BTKIs. Through exploratory analysis using Epic Cosmos, aspergillosis occurred not infrequently (0.5%\u20131.9%) in patients on various BTKIs. Of patients on ibrutinib with a diagnosis of chronic graft-versus-host disease, aspergillosis was identified in 32 (8.3%) patients. Patients on BTKIs who developed aspergillosis were frequently on corticosteroids. Mucormycosis in patients on BTKIs was rare (&lt;0.1%).<\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/asmcr.00087-25","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T14:00:38Z","timestamp":1764165638000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Bruton tyrosine kinase inhibitors and invasive aspergillosis and mucormycosis: a case report and multi-center exploratory retrospective study"],"prefix":"10.1128","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7661-2976","authenticated-orcid":false,"given":"Eric","family":"Bhaimia","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01j7c0b24","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Russell","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01j7c0b24","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Pathology, Rush University Medical Center","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-0371","authenticated-orcid":true,"given":"Carlos A. 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Recent approval of pirtobrutinib for mantle cell lymphoma. 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