Mucormycosis: Atypical Presentation and The Associated Red Flags

Mucormycosis: Atypical Presentation and The Associated Red Flags

Author(s)

Muneera Al-Khalifa,

Abstract

Mucormycosis previously known as zygomycosis is a type of scarce infection caused by fungi. Mucorales is the order that mucormycosis is related to, with Rhizopus being the most common genus. Mucormycosis occurs usually in immunocompromised individuals such as diabetics or posttransplant patients. Diabetes is the most common predisposing factor for rhino-orbital-cerebral mucormycosis.

The first documented case of an upper airway mucormycosis was described by Paltauf, in 1885. Thereafter, Gregory reported three cases of rhinocerebral mucormycosis in 1943. In rhino-orbital-cerebral mucormycosis, the spores adhere to the nasal mucosa and rapidly proliferate in the ideal metabolic hypoxic state found in diabetics. Being an angiotropic fungus, mucor swiftly invades the elastic lamina of the blood vessels, leading to necrosis and ischemic infarctions. Patients with rhino-orbital-cerebral mucormycosis may present with sinusitis, rhinitis, ocular complaints, or facial pain.

Here, we present a subtle presentation of an isolated case of rhinosinusitis mucormycosis in a 50-year-old male presenting to the emergency department with 1-week history of headache aggravated at night and the red flags that lead to the diagnosis. On presentation, the patient was afebrile and generally well. Nasal examination revealed a patch of necrotic mucosa on the nasal septum. The patient was admitted with the differentials of either invasive rhinosinusitis or granulomatous disease.

Nasal swabs were collected revealing a colonization of methicillin-resistant Staphylococcus aureus; nevertheless, the red flags that lead to suspecting a more aggressive infection were the complain of paresthesia of the cheek and upper lip, a necrotic patch on the hard palate, and the aggravated nocturnal headache. The definitive diagnosis was achieved by histopathology demonstrating the importance of high index of suspicion in such cases.

Saudi Journal of Otorhinolaryngology Head and Neck Surgery

DOI:10.4103/SJOH.SJOH_14_19

Available on: https://www.sjohns.org/text.asp?2020/22/1/28/285550