Neurological Presentation of Invasive Mucormycosis

An elderly female presented to the emergency department with a right-sided facial droop and headache for two weeks. Investigations revealed poorly controlled diabetes, and the patient was found to be in diabetic ketoacidosis. Maxillofacial computed tomography (CT) demonstrated right postseptal cellulitis with concern for acute invasive fungal sinusitis. The patient was taken to the operating room for orbital surgical exploration and antrostomy. Surgical pathology revealed broad hyphae consistent with Rhizomucor species, and the patient was diagnosed with mucormycosis. Because the patient was not clinically improving, further imaging was obtained, which showed a large right retroantral phlegmon extending into the cranial fossa and right cavernous sinus, and the patient subsequently underwent surgical debridement. The following postoperative day, the patient was stroke-alerted due to altered mental status and inability to follow commands. She was found to have a small embolic infarct. Due to the poor prognosis of the patient, she was discharged with hospice. Mucormycosis is more commonly found in immunocompromised patients, such as those with uncontrolled diabetes mellitus but very rarely does it involve the cranium. This disease process is very important to recognize early due to high morbidity and mortality rates and devastating outcomes.