Abstract
A 54-year-old diabetic male, with idiopathic CD4 + lymphocytopenia, was presented with a two-month history of headache and periocular pain followed by vertigo, left hypoacusia and left peripheral facial palsy and hypoesthesia. More than a month after admission, a palate ulcer appeared and Infectious Diseases consultation was required. Mucormycosis was suspected and the diagnosis was confirmed by histologic examination. Despite early surgery and combination antifungal therapy, the patient did not survive. This case report illustrates the difficulty in diagnosing a rare condition with non-specific clinical manifestations and underlines the importance of a timely multidisciplinary approach in order to recognise this highly fatal disease earlier. It also describes a previously non-reported situation of mucormycosis in a patient with idiopathic CD4 + lymphocytopenia.
Highlights
Mucormycosis is a life threatening fungal infection caused by Mucorales fungi
We present a case of ROCM in a diabetic patient with idiopathic CD4 + lymphocytopenia (ICL), to our knowledge, a previously non-described association
Hard palate biopsy confirmed the clinical suspicion of mucormycosis (Figures 1(b) and (c)) and the patient was started on amphotericin B deoxycholate (1 mg/Kg/day), rapid dexamethasone tapering and aggressive glycaemic control
Summary
Mucormycosis is a life threatening fungal infection caused by Mucorales fungi. There are six major clinical forms of the disease: cutaneous, pulmonary, gastrointestinal, disseminated, uncommon rare forms (endocarditis, osteomyelitis, peritonitis and renal infection) and rhino-orbito-cerebral (ROCM) [1]. The latter is the most common form and is associated with diabetes in approximately two-thirds of cases [2]. Other risk factors for mucormycosis include haematological malignancies, hematopoietic stem cell and solid organ transplantation, imunossupresssive drugs, deferoxamine therapy and prolonged use of voriconazole [1]. We present a case of ROCM in a diabetic patient with idiopathic CD4 + lymphocytopenia (ICL), to our knowledge, a previously non-described association
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