Mucormycosis in patients with complicated cirrhosis

Rhino-orbito-cerebral mucormycosis is a rapidly progressive and fatal disease that mostly occurs in patients with diabetes mellitus and immunocompromised status. Antifungal therapy with surgical debridement is the standard of care. Patients with cirrhosis of liver are more prone to develop different infections. Many of these also show glucose intolerance or frank diabetes mellitus. Little is known about the clinical presentation and outcome of mucormycosis in patients with cirrhosis. Treatment is difficult due to underlying coagulopathy and hepatic dysfunction.

Medical records of the past five years were searched for the cirrhotic patients admitted with associated diagnosis of mucormycosis or fungal infection. Six patients with mucormycosis were identified.

Out of six patients, five were male. Age range was 15-57 years. Cause of cirrhosis was hepatitis C in four patients, hepatitis B in one patient and autoimmune hepatitis in one patient. Two patients had hepatocellular carcinoma. Four patients had diabetes mellitus, of which one patient was also on steroids for the autoimmune liver disease. Four patients had spontaneous bacterial peritonitis at the time of admission. All six patients presented with rhino-orbitocerebral mucormycosis with nasal discharge and upper motor neuron signs. Diagnosis of mucormycosis was made by culture of biopsy and scrapings taken from the palate and nasal sinuses. These patients received amphotericin B. Four patients died while in the hospital, while two patients died within next few days after discharge.

Mucormycosis in cirrhosis is not very common and has a poor prognosis. Patients with advanced cirrhosis and diabetes mellitus are at risk of developing infection.