Mucormycosis mimics cerebrovascular accident(CVA): How could a complicated case mismanaged

Introduction: Mucormycosis is a mysterious invasive infection that could mimic some other benign problems, so easily leads to misdiagnosis and mistreatment. Here we present such a complicated case.Case presentation:An 80 y/o female was admitted to our ED with a complaint of sudden right hemiparesis of the face and limbs, a tongue swelling and mild right ptosis. Her first neurological assessment such as brain CT scan and routine lab tests were within the normal range. She had also warm eczematic erythematous wounds on both legs, from 2 months ago. As has not an acute episode, she discharged with ASA, Plavix and cephalexin. During the follow up she had several episodes of epistaxis and platelet count depletion. In this stage, the lower extremity biopsy revealed T-cell lymphoma. Subsequent evaluations showed an invasive Sino cerebral mucormycosis. Her prompt surgical procedure and extensive resection were not successful and she died 2 days later. Results: Mucormycosis could presented in vast clinical manifestations and involves various organs such as rhino cerebral, sinuses, lung and even the gastrointestinal tract but CNS involvement and delayed surgery are the two main poor prognostic factors. Combination of lymphoma and mucormycosis is extremely rare; but these two entities have similar symptoms and may even exacerbate each other. Conclusion: Mucormycosis has weak pathogenicity in a healthy human but it could present as a catastrophic entity in immunocompromised patients such as diabetes mellitus, leukaemia and lymphoma. High clinical suspicious is the key to save the patient. However, promote diagnosis followed by an invasive treatment is essential.

Keywords:

Mucormycosis , lymphoma , diabetes mellitus , ptosis , cerebrovascular accident(CVA)