Isolated cerebral mucormycosis: A case discussion

Area of Science:

• Neurology
• Endocrinology
• Toxicology

Background:

• A 32-year-old male with type 1 diabetes, inhaled drug use, and alcohol use disorder presented with acute neurological decline.
• Initial presentation included diabetic ketoacidosis (DKA), encephalopathy, seizures, and altered mental status.

Observation:

• The patient exhibited progressive neurological deterioration, including stupor, right third nerve palsy, and decerebrate posturing.
• Cerebrospinal fluid (CSF) analysis showed mild pleocytosis and hyperglycemia, while blood cultures remained negative.
• Neuroimaging revealed right hemispheric slowing on EEG and diffusion restriction in the right frontal lobe on MRI, suggestive of cerebral edema.

Findings:

• Despite initial management, the patient remained ventilator-dependent with worsening neurological status.
• Diagnostic challenges were compounded by multiple comorbidities and unclear etiology of neurological deterioration.
• Hypertonic saline was initiated for suspected cerebral edema.

Implications:

• This case underscores the complexity of diagnosing neurological emergencies in patients with co-existing medical and substance use disorders.
• Highlights the need for a comprehensive and prompt diagnostic and management strategy.
• Emphasizes the critical role of advanced neuroimaging and multidisciplinary care in such complex cases.