Retrieved from the jaws of death – A successfully managed case of rhino- cerebral mucormycosis despite healthcare constraints due to economic turmoil

Abstract

Rhino- orbital-cerebral mucormycosis is a rapidly progressive life-threatening fungal infection which primarily affects the nose, paranasal sinuses and orbit. It is an opportunistic fungal infection caused by fungi of order Mucorales. They are a group of ubiquitous fungi which grow on decaying vegetation and a wide variety of organic compounds, and they pose a huge threat to life by direct invasion of the vital structures in the body. Early identification and treatment of this disease is therefore of paramount importance for a better outcome. We report a case of a 65-year-old man with a background history of poorly controlled type 2 diabetes mellitus, hypertension and chronic kidney disease, who presented with a diffuse headache of 5 days along with left sided facial oedema, redness of left eye and visual disturbance. Imaging studies revealed sinusitis involving multiple sinuses and the nasal mucosal biopsy showed fungal hyphae. Considering the clinical presentation and the overall findings from the investigations a diagnosis of rhino-cerebral mucormycosis was made. Medical management was done with administration of intravenous Amphotericin B and IV itraconazole along with other supportive medication. Patient had a successful recovery after a lengthy hospital stay which included surgical debridement of affected tissues and the medical treatment even with challenges faced due to unavailability of drugs due to economic constraints on health.