Mucormycosis is an invasive disease caused by filamentous fungi belonging to the order Mucorales. It affects the central nervous system by direct extension from infected paranasal sinuses or by hematogenous dissemination, typically originating in the lungs. A 51-year-old female with poorly controlled type 2 diabetes mellitus denied smoking, alcohol use, or allergies. In August 2024, she developed frontal and paranasal sinus headache with nasal discharge and fever. Oral antibiotics were initially prescribed; however, she progressed with clinical worsening, periorbital edema, subpalpebral hematoma, mental status changes, and progressive visual loss, and was transferred to the ICU. She developed hypertension, tachycardia, and oxygen saturation of 94% on room air. During the investigation, she underwent endoscopic nasal debridement, which confirmed rhino-cerebral mucormycosis, with fungal hyphae and tissue necrosis. Laboratory tests showed leukocytosis, elevated C-reactive protein, and severe hyperglycemia. MRI demonstrated signs of a large acute bilateral frontal hemorrhagic lesion. Treatment was initiated with liposomal amphotericin B (total dose 16,800 mg) plus isavuconazole, as well as ceftriaxone, vancomycin, and metronidazole for secondary bacterial skin infection, correction of hydroelectrolytic disturbances, and glycemic control. With further clinical worsening, blood culture grew Klebsiella pneumoniae ; catheter-associated bloodstream infection was treated with Torgena for 10 days. After treatment, the patient improved clinically with neurological stability. In January, she was re-evaluated due to headache episodes and nasal discharge; pansinusectomy was noted with no further complications, and long-term follow-up was planned with isavuconazole 200 mg/day and prolonged monitoring. The patient’s clinical history, imaging and laboratory findings, and hospital course clearly demonstrate the complexity and aggressiveness of this opportunistic infection. Mucormycosis shows tropism for blood vessels, which may explain local necrosis and the potential for cavernous sinus thrombosis and intracranial hemorrhage, as observed in this case.
Oliveira et al. (Sun,) studied this question.