Isolated cerebellar mucormycosis, slowly progressive over 1 year in an immunocompetent patient

Abstract

Background:Mucormycosis is a rare, aggressive fungal disease with high mortality, typically presenting as rhinosinusitis in immunocompromised patients.Case Description:A 43-year-old man with a history of intravenous drug use, Hepatitis C, and no evidence of immunocompromise presented with worsening balance problems. He had received intravenous antibiotics 2.5 years earlier for local infection after injecting heroin into a neck vein. Imaging studies revealed a lesion, likely of neoplastic origin. At resection, purulent fluid sampled by neuropathology revealed right-angled, branching hyphae, suggesting mucormycosis. No further resection was performed, no other disease sites were found, and HIV findings were negative. Two weeks postoperatively, he developed renal failure; intravenous antifungal treatment and hemodialysis were discontinued. When kidney function recovered 2 weeks later, he declined additional treatment.Conclusion:In our immunocompetent patient, both the location of the infection in the posterior fossa and its slowly progressive characteristic were unique variations of this typically aggressive disease.

Cerebellar Mucormycosis in a Young Man: A Case Report

“…In these cases, the brain is infected subsequent to hematogenous spread of mucorales from pulmonary foci or due to intravenous drug abuse (4-6). Air et al have reported a case of cerebellar involvement without a primary focus and the patient had a history of intravenous drug abuse (1). Regarding the pulmonary mass and the results of the biopsy, it is highly probable that the primary source of infection in our patient is pulmonary and it could be disseminated through hematogenous spread.…”

“…The clinical course of the disease in our patient was slow and after a period of fever and cough, it was presented as vertigo and imbalance. The majority of reports have indicated an acute and progressive course although some chronic cases of pulmonary, paranasal, and intracranial mucormycosis have been reported (1).…”

“…It mostly occurs in patients with poorly controlled diabetes mellitus, hematological malignancies or in patients receiving immunosuppressive treatment after organ transplantation and intravenous drug abusers. High levels of serum iron and treatment with deferoxamine have been also reported as predisposing factors to this infection (1,2).…”

Successful Management of a Unique Condition of Isolated Intracranial Mucormycosis in an Immunocompetent Child

“…However, most isolated cases occur in immunosuppressed patients who suffer from systemic conditions or intravenous drug addiction [8,9]. Interestingly, there have been 5 reports in the literature on isolated brain infection due to mucormycosis in immunocompetent patients [5,8,10]. Among these, only 1 case was reported in a child [10].…”

“…Common routes of brain infection are either through direct expansion from the paranasal sinuses and the orbits, as in ROC type infections, or through hematological dissemination [4]. Isolated cases of mucormycosis have been reported in patients with no rhino-orbital expansion, dissemination from other locations or head trauma [3,5,6,7]. However, most isolated cases occur in immunosuppressed patients who suffer from systemic conditions or intravenous drug addiction [8,9].…”