Background: Mucormycosis is rare, life-threatening fungal infection. Frequently observed in those patients having underlying immunosuppression such as, diabetes, organ transplantation, Human immunodeficiency virus (HIV) infection, and elevated serum iron. However, invasive intestinal mucormycosis occurring in immunocompetent individuals without the traditional risk factors is extremely rare clinical phenomenon. Case presentation: We report a 40-year-old male patient who presented with 1 week history of diffuse abdominal pain and high grade fever, associated with vomiting and frequent loose stools. Has history of chronic alcohol ingestion. Otherwise, no past history of chronic medical illness, nor he had contact with individuals with similar illness. He was in a septic shock with multiple organ failure up on presentation to emergency room. Physical examination revealed icterus sclera with abdominal tenderness. He was immediately resuscitated using crystalloids, supported with inotrope, and antibiotics. Histopathological examination of tissue sample from colonic ulcer biopsy revealed invasive intestinal mucormycosis. Patient showed full clinical and histopathological resolution after course of parenteral Liposomal Amphotercin B. Conclusion: This case highlights the fact that, despite its life-threatening nature, it's possible to treat patients with invasive intestinal mucormycosis with aggressive antifungal and supportive care without surgical intervention, provided that all the necessary supportive care were initiated early and the disease was diagnosed early and appropriate medical management was initiated timely. In addition, it's important to consider intestinal mucormycosis even in patients who are immunocompetent without traditional risk factors.
BACKGROUND: Disorders of the pituitary gland and the sellar region present a wide spectrum of clinical problems. A variety of lesions in this area tend to present with similar problems; namely, headache, hormonal disorders, and loss of vision. Benign adenomas of the pituitary gland are by far the most common disorders of sellar region. Rarely, patients with pituitary adenoma may present with blindness in one eye and visual field cut (temporal hemianopia) in the contralateral eye. This rare clinical entity is called Foster-Kennedy Syndrome (FKS).CASE PRESENTATION: We present a 21-year-old male patient, presented with progressive visual disturbance of the left eye, associated with global headache. The headache was refractory to over-counter medications. In addition, he had history of sleep disturbance and loss of appetite. Neurological examination was pertinent for left side visual loss with optic atrophy and right eye temporal visual field cut with disc edema. Brain MRI showed 4 cm X 3.5 cm sized lobulated intra and supra sellar mass with heterogeneous contrast enhancement and minimal surrounding edema. Serum prolactin level was 6,705 ng/mL. Otherwise, the other pituitary hormones were in normal range.CONCLUSION: This case highlighted that pituitary adenoma may present with the full picture of Foster Kennedy syndrome. Therefore, we recommend considering pituitary adenoma as a possible differential diagnosis of intracranial lesions presenting as Foster Kennedy syndrome, as early detection and management could potentially salvage patients’ vision and quality of life.
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