Isolated cerebral mucormycosis masquerading as a tumor in an immunocompetent patient

Abstract

Mucormycosis is an opportunistic fungal disease that commonly presents as cutaneous or rhinocerebral infections associated with immunocompromised states. It may exceptionally present as isolated involvement of the brain with a varied clinical presentation, which may be difficult to diagnose early, leading to increased mortality. Herein, we report the case of a 42-yearold immunocompetent female with left-sided limb weakness and a history of recurrent vomiting and headache for the last two years. Clinically, glioma was suspected, but histopathological examination revealed a few broad aseptate fungal hyphae. As no other organ was involved, the diagnosis of isolated cerebral mucormycosis was rendered. Reporting this case, we show an unusual presentation of a central nervous system mucormycosis masquerading a tumor in an immunocompetent patient. The case also highlights the importance of a careful histopathological examination to avoid missing the presence of occasional fungal hyphae. Ideally, recognition of fungal hyphae in the brain, during intraoperative consultation, can prompt brain tissue culture for definitive diagnosis and early empirical antifungal therapy, which may prove life-saving.

Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case

“…To our knowledge, four additional cases of isolated intracerebral mucormycosis that would have met their inclusion criteria have been published since. 9,[18][19][20] We believe that our case marks the 60th case and, notably, is the only one in the modern era of MRI with obstructive hydrocephalus but without specific infectious radiographic findings.…”

“…There are 59 reports of isolated cerebral mucormycosis in immunocompetent adult patients. [16][17][18][19][20] Among those, the vast majority had a focal mass lesion or radiographic infectious sequelae on magnetic resonance imaging (MRI). 3,8,17,19,[21][22][23] Only three to date have reported obstructive hydrocephalus secondary to mucormycosis without an evident infectious process on neuroimaging, although all occurred in the 1980s before the advent of MRI [24][25][26] and only one was diagnosed and appropriately treated before death.…”

“…[16][17][18][19][20] Among those, the vast majority had a focal mass lesion or radiographic infectious sequelae on magnetic resonance imaging (MRI). 3,8,17,19,[21][22][23] Only three to date have reported obstructive hydrocephalus secondary to mucormycosis without an evident infectious process on neuroimaging, although all occurred in the 1980s before the advent of MRI [24][25][26] and only one was diagnosed and appropriately treated before death. 25 Here, we present our experience with a rare case of adult obstructive hydrocephalus caused by Rhizopus infection in an immunocompetent patient, with the obstruction and infection both diagnosed only at the time of surgery.…”

Mucormycosis and COVID-19-Associated Mucormycosis: Insights of a Deadly but Neglected Mycosis

“…As mentioned before, these fungi are ubiquitously found in the environment, and their ability to cause disease in immunocompetent hosts is anecdotic but possible [ 48 ]. In the majority of the cases, the patients have underlying health conditions [ 40 , 49 , 50 ].…”

COVID-19 Associated Rhino-Orbital Mucormycosis Complicated by Gangrenous and Bone Necrosis—A Case Report from Honduras

“…Mucormycosis is a fairly rare but life-threatening invasive fungal infection caused by various genera and species of the order Mucorales, with six families being the most common Mucoraceae affecting immunocompromised patients [ 1 ]. Mucormycosis most commonly occurs in patients with underlying host defense defects and increased serum iron availability, although sporadically, immunocompetent hosts may be affected [ 1 , 2 , 3 ]. Mucormycosis is also an important emerging condition among patients with haematological malignancies, allogeneic stem cell transplantation, and diabetes mellitus [ 4 ].…”