Rhinocerebral mucormycosis complicated by massive cerebral hemorrhage

Abstract

Rhinocerebral mucormycosis is a rare but usually fatal infection caused by fungi from the order Mucorales. These fungi has strong predilection for growth into arteries, lymphatics and nerves and this is the reason for their rapid spread to adjacent tissues with accompanying tissue ischemia and infarction due to vascular occlusion after a fibrin reaction and mucor thrombus. We describe a 54 year old Thai national male with poorly controlled type 2 diabetes, ischemic heart disease, hypertension and renal impairment who presented to the emergency department with fever, vomiting and painful left eye swelling, which progressed rapidly leading to complete opthalmoplegia and vision loss. The diagnosis of mucormycosis was confirmed later and was the patient was started on Amphotericin B therapy. Despite stable clinical course, he suddenly developed a fatal intracerebral hemorrhage and died within 24 hours of the bleed. We wonder weather patients with cerebral fungal infection should perhaps have an early neurosurgical intervention to rule out the presence of mycotic aneurysm; particularly that many cases of fatal cerebral bleed have been reported in association with Rhinocerebral mucormycosis.