A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion

Abstract

Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.