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Perineural spread of rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans

Kirti Parsi1, Raghavendra K Itgampalli, R Vittal

  • 1Department of Radiodiagnosis, Yashoda Hospitals, Hyderabad/Secunderabad, India.

Annals of Indian Academy of Neurology
|October 9, 2013
PubMed

Insights

This study details the first reported case of rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans spreading along the trigeminal nerve. The infection occurred in an immunocompetent, non-diabetic individual, highlighting unusual disease presentation.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Rhino-orbitocerebral mucormycosis (ROCM) is a severe fungal infection typically seen in immunocompromised or diabetic patients.
  • Apophysomyces elegans is a less common cause of mucormycosis, with potential to affect even healthy individuals.
  • Standard ROCM spread occurs via direct invasion or hematogenous routes, with perineural spread being rare.

Observation:

  • A 25-year-old, immunocompetent, and non-diabetic individual presented with ROCM.
  • The infection, caused by Apophysomyces elegans, demonstrated an unusual pattern of perineural extension.
  • The spread was specifically documented along the trigeminal nerve.

Findings:

  • This case represents the first documented instance of perineural extension of ROCM by Apophysomyces elegans.
  • The trigeminal nerve served as a pathway for the fungal invasion.
  • The patient's immunocompetent and non-diabetic status challenges typical etiological assumptions for ROCM.

Implications:

  • Highlights the potential for Apophysomyces elegans to cause invasive disease in immunocompetent hosts.
  • Suggests that perineural spread should be considered in the differential diagnosis of ROCM, even in atypical patient profiles.
  • Underscores the need for broader diagnostic considerations in fungal infections beyond traditional risk factors.
Keywords:
Magnetic resonance imagingperineural spreadrhino-orbitocerebral mucormycosissinusitistrigeminal nerve

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