Rhinocerebral mucormycosis is a life threatening fungal infection occurring in humans, which is caused by the ubiquitous saprophytic fungi of order Mucorales. A timely diagnosis in patients with predisposing factors leading to immunosuppression is of great importance in reducing mortality and morbidity. We describe a patient presenting with typical clinical manifestations of rhinocerebral mucormycosis involving the paranasal sinuses and the orbit. Keywords: Mucormycosis, fungal infection, rhizopus, amphotericin B, surgical debridement Case reportA 39 year old male patient presented to a medical ward with a history of fever, left sided earache with discharge and headache for 1 month; swelling, weakness and numbness of left side of the face for 10 days with drooping and difficulty in moving the left eye for 4 days. He was a noncompliant type II diabetes mellitus patient for 9 years and a heavy alcoholic. A diagnosis of left sided otitis media, mastoiditis and sinusitis was made at another institute. A non-contrast CT scan of petrous-temporal bones and paranasal sinuses done due to the facial symptoms revealed acute sinusitis involving the left frontal, maxillary, sphenoid and bilateral ethmoid sinuses and left sided mastoiditis with otitis media.On examination he was conscious and rational, afebrile and had no signs of meningism but had complete ptosis of the left eye, proptosis and lid oedema, left sided complete ophthalmoplegia and V and VII cranial nerve palsies.On admission his capillary blood sugar was 293mg/dl and WBC was 8600/mm 3 (DC-N 53.8%, L 36.6%). Oral hypoglycaemics, nasal decongestants, antihistamines and empirical antibiotics were started. An urgent referral was made to the ENT surgery team as mucormycosis was high in the differential diagnoses. A rigid nasal endoscopy (RNE) revealed fungal debris and pus in the left maxillary region and polypoidal lesions lateral to the maxillary turbinate. A biopsy of the latter was sent for histology. The patient was transferred to the ENT ward. Histology report suggested a fungal infection, possibly mucormycosis. Three days later, another RNE and
Haematological malignancies are at a high risk of fungal infection and subsequent high mortality. A patient with a relapsed acute lymphocytic leukaemia (ALL) and a rare fungal infection is presented.A four-year-old patient with ALL relapsed after 3 years of remission. He presented with a papular, erythematous rash mainly on the limbs and trunk, accompanied with high intermittent fever which did not respond to broad spectrum antibiotics.Histopathological examination of a skin biopsy revealed yeast cells. Trichosporon species was isolated on culture. Voriconazole was started according to sensitivity test results and a brief response was demonstrated. Clinical deterioration was seen with worsening of the underlying malignancy. Amphotericin B was added with poor response. Unfortunately, he succumbed to his disease process without recovery from fever, skin rash or the malignancy.Trichosporon species is a rare infection even in patients with haematological malignancies. Recovery from neutropenia is an important prognostic factor in the treatment of trichosporonosis.
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