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Mucormycosis: A sweet enemy, case series
Santiago Manrique-Castaño1, Luis Armando Velásquez-Trujillo1, Mariana Ángel Correa2
1Departamento de Medicina Interna, Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia.
Abstract:
Mucormycosis is a rare fungal infection caused by fungi of the Mucorales order that occurs in immunocompromised individuals or with loss of skin or mucosa barrier integrity. This report presents four cases of rhinocerebral mucormycosis attended at a third-level hospital in Cali (Colombia) during a period of three years. All patients had different case histories and times of evolution. All four had a previous or de novo diagnosis of type 2 diabetes mellitus, with glycated hemoglobin higher than 10% on admission. We ruled out other possible pathologies that could explain their immunocompromised condition. Mucormycosis diagnosis was made with direct visualization of hyaline coenocytic hyphae on biopsies. The basis of treatment was liposomal amphotericin B and surgical debridement. Two patients presented bacterial coinfection. One asked for voluntary discharge without having completed the treatment, and another one died. The remaining two have attended controls and had an adequate evolution.
Insights
Rhinocerebral mucormycosis, a rare fungal infection, affects immunocompromised individuals, particularly those with uncontrolled type 2 diabetes mellitus. Early diagnosis and treatment with liposomal amphotericin B and surgery are crucial for better outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Ophthalmology
Background:
- Mucormycosis is a rare, life-threatening fungal infection caused by Mucorales fungi.
- It primarily affects immunocompromised individuals or those with compromised skin/mucosal barriers.
- Rhinocerebral mucormycosis is a severe form affecting the sinuses and brain.
Purpose of the Study:
- To report four cases of rhinocerebral mucormycosis in Cali, Colombia.
- To highlight the association with type 2 diabetes mellitus and poor glycemic control.
- To discuss diagnosis, treatment, and outcomes of this rare infection.
Main Methods:
- Case series of four patients with rhinocerebral mucormycosis over three years.
- Diagnosis confirmed by direct visualization of fungal hyphae in biopsies.
- Assessment of patient history, comorbidities (especially diabetes), and treatment response.
Main Results:
- All four patients had type 2 diabetes mellitus with high glycated hemoglobin (>10%).
- Treatment involved liposomal amphotericin B and surgical debridement.
- Outcomes varied: one patient died, one left treatment, and two showed adequate recovery.
Conclusions:
- Uncontrolled diabetes is a significant risk factor for rhinocerebral mucormycosis.
- Prompt diagnosis and aggressive treatment (antifungal therapy and surgery) are vital.
- Effective management requires addressing underlying conditions and potential coinfections.
