Unusual presentation of mucormycosis mimicking a localised sino-orbital pathology

Abstract

Mucormycosis is an aggressive and deadly fungal infection, which is invariably associated with an immunocompromised patient. Mucormycosis in the head and neck region presents as skeletal necrosis, with or without soft tissue involvement. Early identification and treatment with combination of surgical debridement and parenteral antifungal therapy is critical for a favourable outcome. This paper reports an unusual presentation of mucormycosis, mimicking a localised sino-orbital pathology involving the infraorbital subcutaneous tissue and the maxillary sinus, in a 35 years old immunocompetent man. Despite aggressive antifungal therapy and surgical management, the course of disease was fatal, reiterating the high mortality associated with mucormycosis.

Keywords: oral and maxillofacial surgery; otolaryngology / ENT.

Figure 1

(A) Preoperative clinical photograph showing localised subcutaneous swelling in left infraorbital area and MRI (B) coronal and (C) axial sections showing well-defined lesion involving the anterior wall of the left maxillary sinus.

Figure 2

H&E stained sections showing multiple caseating granulomas with numerous giant cells (10x) (A) and foreign body type of giant cells with fungal elements (40x) (B).

Figure 3

Gomori methamine silver stained photomicrograph demonstrating fungal elements within the necrotic material and giant cells, seen in 10x (A) and 40x magnification (B).

Figure 4

Intraoperative images showing (A) incision marking, (B) surgical site, (C) excised lesion and (D) closure.