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Otocerebral mucormycosis--a case report
R A Macdonell1, G A Donnan, R M Kalnins
1Department of Neurology, Austin Hospital, Heidelberg, Victoria.
Abstract:
Mucormycosis is an often fatal infection caused by ubiquitous organisms of the order Mucorales. Infection is most commonly seen in the immunocompromised host, particularly in the setting of diabetic ketoacidosis. The most common presentation is with rhinocerebral involvement. We here report a case of otocerebral mucormycosis occurring in an elderly man with maturity onset diabetes who was not acidotic. The unusual site of infection delayed diagnosis until the pons had been invaded by the infecting organism which was demonstrated as a hypodense area on CT scan. Consequently radical excision of infected tissue was not feasible and the patient died. At post-mortem examination there was extensive infection and infarction of the parotid gland, inner ear and pons associated with arterial invasion by the fungus and septic cavernous sinus thrombosis. The case is described to demonstrate the existence of other modes of neurological presentation of mucormycosis apart from the well recognized rhinocerebral form. Early diagnosis is the key to successful therapy.
Insights
Mucormycosis, a severe fungal infection, can present unusually in the ear and brain, even without diabetic ketoacidosis. This case highlights the importance of early diagnosis for treating this often fatal condition.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Mucormycosis is a life-threatening fungal infection caused by Mucorales.
- It predominantly affects immunocompromised individuals, often linked to diabetic ketoacidosis.
- Rhinocerebral involvement is the most frequent clinical presentation.
Observation:
- A case of otocerebral mucormycosis in an elderly male with maturity onset diabetes is presented.
- The patient was not in diabetic ketoacidosis, and the infection site was unusual.
- Diagnosis was delayed due to the atypical presentation, with the pons already invaded.
Findings:
- Computed Tomography (CT) scan revealed a hypodense area indicating fungal invasion of the pons.
- Post-mortem examination showed extensive infection and infarction of the parotid gland, inner ear, and pons.
- Fungal arterial invasion and septic cavernous sinus thrombosis were identified.
Implications:
- This case expands the understanding of neurological presentations of mucormycosis beyond the common rhinocerebral form.
- It underscores the critical need for prompt diagnosis in atypical presentations.
- Early therapeutic intervention is crucial for improving outcomes in mucormycosis.