Mucormycosis is a severe infection caused by fungi of the order Mucorales, characterized by vascular invasion and tissue necrosis. Clinical forms include rhino-cerebral, pulmonary, cutaneous, disseminated, and other rare presentations. Although classically associated with immunocompromised patients and, more recently, severe COVID-19 cases, its occurrence in otherwise healthy individuals can be fatal. We report the case of a 23-year-old woman with no known comorbidities, living in a rural area, who sought emergency care for pain, edema, and erythema of the right hemiface with an eight-day evolution. The condition was associated with nasal congestion and a central necrotic ulcer in the right maxillary sinus. She underwent surgical debridement, and gross examination of the lesion revealed an irregular, brownish-yellow fragment with a granular surface. Histopathological analysis demonstrated extensive adipose necrosis, bacterial colonies, and numerous broad fungal hyphae (positive on Grocott staining) invading vascular walls and forming thrombi. The final diagnosis was primary cutaneous mucormycosis with progression to the rhino-cerebral form and acute invasion of the right maxillary sinus. Antifungal treatment with amphotericin B led to infection reversal. The acute presentation of cutaneous and rhino-cerebral mucormycosis in an immunocompetent patient is remarkable in recent literature. The favorable outcome, directly attributed to early diagnostic intervention, highlights the role of biopsy and histopathological examination in identifying angioinvasive lesions and guiding appropriate treatment. This report contributes to broadening the understanding of the epidemiological diversity of mucormycosis and reinforces the need to include it in the differential diagnosis of necrotic facial lesions. The aggressive nature and high lethality of mucormycosis require immediate diagnosis and intervention, regardless of the presence of classic risk factors.
Hawerroth et al. (Sun,) studied this question.