Neurological Presentation of Invasive Mucormycosis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neurosurgery

Background:

• Mucormycosis is a rare but aggressive fungal infection, often affecting immunocompromised individuals, particularly those with uncontrolled diabetes mellitus.
• Invasive fungal sinusitis can rapidly progress, leading to severe complications if not diagnosed and treated promptly.

Observation:

• An elderly female presented with facial droop and headache, later diagnosed with diabetic ketoacidosis and suspected invasive fungal sinusitis.
• Maxillofacial CT revealed right postseptal cellulitis, prompting surgical exploration and biopsy.
• Surgical pathology identified broad hyphae consistent with Rhizomucor species, confirming mucormycosis.

Findings:

• The patient developed a retroantral phlegmon extending into the cranial fossa and cavernous sinus, requiring surgical debridement.
• Postoperatively, the patient experienced an embolic infarct secondary to altered mental status.
• Despite aggressive management, the patient had a poor prognosis and was discharged to hospice care.

Implications:

• This case highlights the rare but devastating cranial extension of mucormycosis, even in the absence of typical risk factors.
• Prompt diagnosis and multidisciplinary management are essential for improving outcomes in invasive fungal sinusitis.
• The high morbidity and mortality associated with mucormycosis underscore the importance of early recognition and intervention, especially in diabetic patients.