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Mucormycosis is a fairly rare fungal infection caused by ubiquitous fungi of the order Mucorales and primarily affects immunocompromised hosts. A series of 16 cases of invasive mucormycosis admitted to three referral centres in Beirut, Lebanon between 1981 and 1999 is described. It includes 12 patients with rhinocerebral, three with cutaneous, and one with pulmonary infection. Onset of symptoms occurred in the summer and autumn in 15 out of 16 patients, showing a statistically significant seasonal variation (P=0·007) A recent report of 19 patients from Tel Aviv describes a strikingly similar seasonal pattern. Studies on atmospheric concentration of Mucorales spores in the Eastern Mediterranean are lacking. Weather pattern analysis in Beirut revealed clustering of onset of invasive mucormycosis at the end of a dry, warm period, which begins around May and ends in October. Mucormycosis incidence appears to be seasonal in the Eastern Mediterranean.

Abstract: Small-cell lung carcinoma (SCLC) represents one-fifth of all cases of bronchopulmonary cancer and has a 5-yr survival of 2–4%. Long-term survivors of SCLC are at risk for developing second primary aerodigestive tumors. We report a case of a long-term survivor who had a 10-yr disease-free survival between two diagnoses of SCLC. A literature review identified four case reports and seven review series with a total of 26 cases of 5-yr disease-free survivors of SCLC who developed a second SCLC. A total of 4574 patients were reported in the review series. Five-year disease-free survival was documented in 139 of 4574 patients. Twenty-two (15.8%) of those developed a second SCLC over the next 7 yr of follow up, with an averaged annual incidence equal to fivefold that of the general population. Earlier reports of a slow radiographic doubling time for some cases of SCLC suggests that survivors of SCLC may still develop a recurrent SCLC following 12 yr of disease-free follow up. It remains difficult to ascertain whether a second SCLC is a recurrence or a second primary tumor in the absence of a preneoplastic lesion for SCLC. New genetic markers may hold the answer. They may also help screen high-risk patients including survivors of SCLC.