An Instructive Case of Cerebral Mucormycosis
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Published on: September 4, 2017
Belinda Shao1, Matthew J Hagan2, Rahul A Sastry1
1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI.
Background:
Mucormycosis can lead to fatal rhinocerebral infection.
Case:
A 53-year-old male with diabetes presented with altered mental status. He had been recently discharged from an admission for COVID-19 pneumonia treated with remdesivir and methylprednisolone. Imaging demonstrated a large left frontal mass with midline shift suspicious for a primary brain neoplasm. His neurologic exam rapidly declined and the patient was taken to the operating room for decompressive hemicraniectomy. Post-operatively, the patient remained comatose and failed to improve. Autopsy revealed a cerebral mucormycosis infection.
Discussion:
Despite concern for a primary brain neoplasm the patient was diagnosed postmortem with a mucormycosis infection. Other features supporting this diagnosis included nasal sinusitis on initial scans, his fulminant clinical decline, rapidly progressive imaging findings, and persistent hyperglycemia throughout his clinical course.
Conclusion:
In an era of high steroid usage to treat COVID-19, mucormycosis infection must be considered in high-risk patients demonstrating disproportionate clinical decline.
Insights
Mucormycosis, a deadly fungal infection, was diagnosed postmortem in a diabetic patient with COVID-19. High steroid use during COVID-19 treatment necessitates considering mucormycosis in high-risk patients with rapid decline.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neurology
Background:
- Mucormycosis is a severe fungal infection with high mortality.
- Rhinocerebral mucormycosis presents a significant clinical challenge.
Observation:
- A diabetic patient with recent COVID-19 pneumonia developed altered mental status.
- Initial imaging suggested a brain neoplasm, but autopsy revealed cerebral mucormycosis.
Findings:
- The patient exhibited rapid neurological decline and persistent hyperglycemia.
- Nasal sinusitis and aggressive intracranial disease supported the mucormycosis diagnosis.
Implications:
- Cerebral mucormycosis should be considered in immunocompromised patients, especially those with diabetes and recent COVID-19.
- Increased corticosteroid use in COVID-19 management may elevate mucormycosis risk.
