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Diabetes-associated central nervous system mucormycosis with delayed diagnosis: a case report
Geng Jia1, Changchun Yang1, Yi Feng1
1First People's Hospital of Changzhou, Changzhou, China.
Background:
Central nervous system (CNS) mucormycosis is a rare, life-threatening fungal infection predominantly affecting diabetic and immunocompromised patients. Early diagnosis remains challenging, resulting in poor outcomes. We report a case highlighting the diagnostic challenges and rapid progression in a patient with uncontrolled diabetes and COVID-19 infection.
Case Presentation:
A 31-year-old male with untreated type 2 diabetes mellitus presented with severe pneumonia due to COVID-19 infection. His condition rapidly deteriorated, developing CNS symptoms and characteristic nasal lesions. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, high protein, and low glucose. Metagenomic next-generation sequencing (mNGS) of CSF confirmed Rhizopus oryzae infection. Despite initiating amphotericin B therapy, his condition worsened.
Results:
The patient succumbed to progressive multi-organ failure secondary to disseminated mucormycosis. This case emphasizes the significance of uncontrolled diabetes and COVID-19 as critical risk factors and highlights the diagnostic utility of CSF mNGS.
Conclusion:
Prompt recognition of risk factors, early utilization of advanced diagnostic methods, and aggressive treatment are essential to improve outcomes in CNS mucormycosis.
Insights
Central nervous system mucormycosis is a rare fungal infection. Metagenomic sequencing of cerebrospinal fluid aided in diagnosing Rhizopus oryzae in a patient with diabetes and COVID-19.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Central nervous system (CNS) mucormycosis is a rare, life-threatening fungal infection.
- It predominantly affects diabetic and immunocompromised individuals.
- Early diagnosis is challenging, leading to poor patient outcomes.
Observation:
- A 31-year-old male with uncontrolled type 2 diabetes and COVID-19 presented with severe pneumonia.
- The patient rapidly developed CNS symptoms and nasal lesions.
- Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, high protein, and low glucose.
Findings:
- Metagenomic next-generation sequencing (mNGS) of CSF confirmed *Rhizopus oryzae* infection.
- Despite amphotericin B treatment, the patient's condition deteriorated.
- The patient died from multi-organ failure due to disseminated mucormycosis.
Implications:
- Uncontrolled diabetes and COVID-19 are significant risk factors for CNS mucormycosis.
- CSF mNGS is a valuable diagnostic tool for identifying *Rhizopus oryzae*.
- Prompt diagnosis and aggressive treatment are crucial for improving outcomes in CNS mucormycosis.
