A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion

Anna Balaji Karthikeyan; Rakesh Gupta; Zafar Sheikh

doi:doi:10.11648/j.ijn.20220601.11

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A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion

Anna Balaji Karthikeyan, Rakesh Gupta, Zafar Sheikh

Published in International Journal of Neurosurgery (Volume 6, Issue 1)

Received: 6 January 2022 Accepted: 28 January 2022 Published: 9 February 2022

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Abstract

Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.

Published in	International Journal of Neurosurgery (Volume 6, Issue 1)
DOI	10.11648/j.ijn.20220601.11
Page(s)	1-6
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Cerebral Mucormycosis, Solitary Intraparenchymal Lesion, COVID-19, Mucor, Malignant Glioma, Glioblastoma

References

[1]	Multiple brain abscesses from isolated cerebral mucormycosis. Escobar A, Del Brutto OH, J Neurol Neurosurg Psychiatry. 1990 May; 53 (5): 431-3.
[2]	Paranasal sinus mucormycosis: a report of two cases. Ruoppi P, Dietz A, Nikanne E, Seppa J, Markkanen H, Nuutinen J, Acta Otolaryngol. 2001 Dec; 121 (8): 948-52.
[3]	Long-term survival in rhinocerebral mucormycosis. Case report. Weprin BE, Hall WA, Goodman J, Adams GL, J Neurosurg. 1998 Mar; 88 (3): 570-5.
[4]	Isolated cerebral mucormycosis: report of a case and review of the literature. Verma A, Brozman B, Petito CK, J Neurol Sci. 2006 Jan 15; 240 (1-2): 65-9.
[5]	Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2005; 41: 634–653.
[6]	Malik AN, Bi WL, McCray B, et al. Isolated cerebral mucormycosis of the basal ganglia. Clin Neurol Neurosurg 2014; 124: 102–5.
[7]	Kousser C, Clark C, Sherrington S, et al. Pseudomonas aeruginosa inhibits Rhizopus microsporus germination through sequestration of free environmental iron. Sci Rep 2019; 9: 5714.
[8]	Szarpak L., Chirico F., Pruc M., et al. Mucormycosis — a serious threat in the COVID-19 pandemic? J Infect. 2021; 83: 237–239.
[9]	Park Y. L., Cho S., Kim J. W. Mucormycosis originated total maxillary and cranial base osteonecrosis: a possible misdiagnosis to malignancy. BMC Oral Health. 2021; 21: 65.
[10]	Montefusco L., Ben Nasr M., D’Addio F., et al. Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection. Nat Metab. 2021; 3: 774–785.
[11]	Coutinho A. E., Chapman K. E. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011; 335: 2–13.
[12]	Berbudi A., Rahmadika N., Tjahjadi A. I., et al. Type 2 diabetes and its impact on the immune system. Curr Diabetes Rev. 2020; 16: 442–449.
[13]	Imaging of mucormycosis skull base osteomyelitis. Chan LL, Singh S, Jones D, Diaz EM Jr, Ginsberg LE AJNR Am J Neuroradiol. 2000 May; 21 (5): 828-31.
[14]	Craniofacial mucormycosis: assessment with CT. Gamba JL, Woodruff WW, Djang WT, Yeates AE Radiology. 1986 Jul; 160 (1): 207-12.
[15]	MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation. Terk MR, Underwood DJ, Zee CS, Colletti PM Magn Reson Imaging. 1992; 10 (1): 81-7.
[16]	Chronic rhinocerebral mucormycosis. Harrill WC, Stewart MG, Lee AG, Cernoch P Laryngoscope. 1996 Oct; 106 (10): 1292-7.

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APA Style

Anna Balaji Karthikeyan, Rakesh Gupta, Zafar Sheikh. (2022). A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion. International Journal of Neurosurgery, 6(1), 1-6. https://doi.org/10.11648/j.ijn.20220601.11

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ACS Style

Anna Balaji Karthikeyan; Rakesh Gupta; Zafar Sheikh. A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion. Int. J. Neurosurg. 2022, 6(1), 1-6. doi: 10.11648/j.ijn.20220601.11

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AMA Style

Anna Balaji Karthikeyan, Rakesh Gupta, Zafar Sheikh. A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion. Int J Neurosurg. 2022;6(1):1-6. doi: 10.11648/j.ijn.20220601.11

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@article{10.11648/j.ijn.20220601.11,
  author = {Anna Balaji Karthikeyan and Rakesh Gupta and Zafar Sheikh},
  title = {A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion},
  journal = {International Journal of Neurosurgery},
  volume = {6},
  number = {1},
  pages = {1-6},
  doi = {10.11648/j.ijn.20220601.11},
  url = {https://doi.org/10.11648/j.ijn.20220601.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20220601.11},
  abstract = {Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.},
 year = {2022}
}

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TY - JOUR
T1 - A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion
AU - Anna Balaji Karthikeyan
AU - Rakesh Gupta
AU - Zafar Sheikh
Y1 - 2022/02/09
PY - 2022
N1 - https://doi.org/10.11648/j.ijn.20220601.11
DO - 10.11648/j.ijn.20220601.11
T2 - International Journal of Neurosurgery
JF - International Journal of Neurosurgery
JO - International Journal of Neurosurgery
SP - 1
EP - 6
PB - Science Publishing Group
SN - 2640-1959
UR - https://doi.org/10.11648/j.ijn.20220601.11
AB - Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.
VL - 6
IS - 1
ER -

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Author Information

Anna Balaji Karthikeyan

Department of General Surgery, Mahatma Gandhi Memorial Medical College, Indore, India
Rakesh Gupta

Department of Neurosurgery, Mahatma Gandhi Memorial Medical College, Indore, India
Zafar Sheikh

Department of Neurosurgery, Mahatma Gandhi Memorial Medical College, Indore, India

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APA Style

Anna Balaji Karthikeyan, Rakesh Gupta, Zafar Sheikh. (2022). A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion. International Journal of Neurosurgery, 6(1), 1-6. https://doi.org/10.11648/j.ijn.20220601.11

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ACS Style

Anna Balaji Karthikeyan; Rakesh Gupta; Zafar Sheikh. A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion. Int. J. Neurosurg. 2022, 6(1), 1-6. doi: 10.11648/j.ijn.20220601.11

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AMA Style

Anna Balaji Karthikeyan, Rakesh Gupta, Zafar Sheikh. A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion. Int J Neurosurg. 2022;6(1):1-6. doi: 10.11648/j.ijn.20220601.11

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@article{10.11648/j.ijn.20220601.11,
  author = {Anna Balaji Karthikeyan and Rakesh Gupta and Zafar Sheikh},
  title = {A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion},
  journal = {International Journal of Neurosurgery},
  volume = {6},
  number = {1},
  pages = {1-6},
  doi = {10.11648/j.ijn.20220601.11},
  url = {https://doi.org/10.11648/j.ijn.20220601.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20220601.11},
  abstract = {Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.},
 year = {2022}
}

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