An Unusual Presentation of Cryptogenic Pulmonary Mucormycosis Related to COVID-19 Infection - A Case Report

Abstract

Rhizopus arrhizus, a fungus of the Mucoraceae family, results in approximately 70% of cases of human mucormycosis and can cause various clinical syndromes including rhino-orbital-cerebral, cutaneous, gastric, and pulmonary disorders. [1] The diagnosis of mucormycosis is confirmed by the identification of the causative fungal organisms as broad nonseptate hyphae on cytology and isolation of R. arrhizus on cultures. The management of mucormycosis includes early aggressive surgical debridement along with the administration of liposomal amphotericin B. [2] Mucormycosis cases involving the central nervous system typically result from intracranial spread from fungal sinusitis or skull base osteomyelitis leading to cerebritis, meningitis, abscesses, or infarction secondary to vasculitis. [3,4] Mycotic intracranial aneurysms (MIAs) are extremely rare presentations of mucormycosis and most often result from local spread from skull base or cerebral infections. MIAs rarely may be caused from hematogenous seeding from extracranial Mucor infection. [5,6] case report A 57-year-old male patient presented with three episodes of tonic posturing of the right upper and lower limb lasting for 2-3 min followed by transient right hemiparesis for 15-20 min. The patient had a history of low-grade fever with fatigue of 3-week duration. Magnetic resonance imaging (MRI) brain and magnetic resonance (MR) angiography brain and neck vessels following each episode were unremarkable. Electroencephalography, echocardiography, Doppler study of the neck vessels, and cerebrospinal fluid (CSF) examination were normal. Hematological and metabolic parameters were within normal limits except for elevated serum creatinine (2.1 mg/dl) and HbA1c (7.8.). The patient had an 8-year history of diabetes and hypertension with coronary artery disease. The patient had chronic kidney disease IV with a