Mucormycosis of the central nervous system associated with thrombosis of the internal carotid artery.
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A 14-year-old child from Iraq presented with an acute febrile illness accompanied by large necrotic skin lesions and bronchopneumonia from which he subsequently died. The infection was caused by an unusual zygomycete fungus Saksenaea vasiformis. Previous reports of infection with this organism are rare and tissue invasion has usually followed traumatic injury. In the child reported here no predisposing abnormalities were apparent.
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A 42-year-old man, with a history of immunoglobulin A nephropathy, underwent a living-related kidney transplant. Allograft function progressively deteriorated secondary to chronic rejection and recurrence of IgA nephropathy, and he returned to peritoneal dialysis after 5 years of the transplant. Fifteen months after the discontinuation of immunosuppressive therapy, Eschericia coli peritonitis developed, which was treated with ceftazidime intraperitoneally; he received fluconazole as prophylactic antifungal therapy during this period. After completing his course of treatment, abdominal pain occurred with an increased peritoneal fluid white blood cell count. Peritoneal fluid cultures were negative. He received broad-spectrum antibiotics and fluconazole with no appreciable response. After removal of the Tenckoff catheter, peritoneal fluid cultures grew a zygomycete. The patient was treated with liposomal amphotericin B (AmBisome) intravenously for 6 weeks. He had episodes of recurrent intraabdominal abscesses requiring surgical drainage and antibiotics. A second course of liposomal amphotericin B was administered for histopathologic evidence of filamentous fungal recurrence. After 5 months, the patient remains well without any evidence of infection.
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Cavernous sinus thrombosis is a serious condition, which, if not recognized early, can lead to a fulminant course. Knowledge of risk factors along with early recognition of signs and symptoms may alter the course of this condition. We present a case of a patient with cavernous sinus thrombosis with characteristic findings on MRI. Biopsy of the sinuses revealed mucromycosis as the offending agent.
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A case of rhino-orbito-cerebral zygomycosis in a diabetic patient treated with insulin is reported. Diagnosis was suspected because of extensive necrotic lesions of the face and was confirmed by mycologic tests. During hospital stay the patient developed a diabetes insipidus and the outcome was lethal because of the extension of lesions in spite of convenient antimycotic therapy.
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