Rhino-orbital-cerebral mucormycosis caused by Rhizopus arrhizus diagnosis via metagenomics next-generation sequencing: a case report

Abstract

Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, invasive, and fatal fungal disease that is often easily misdiagnosed in the early stages due to the lack of specific clinical manifestations and adequate auxiliary examinations. Early diagnosis and timely therapy are essential for successful treatment. In this report, we presented a 46-year-old man with diabetes who experienced gradual vision loss, right ptosis, swelling, and headaches that progressively worsened to death within 4 days after admission. It was finally confirmed as a fungal Rhizopus arrhizus infection by metagenomics next-generation sequencing (mNGS). Our report has proved that mNGS testing should be strongly recommended in highly suspected patients.

Keywords: Rhizopus arrhizus; diagnosis; fungal infection; metagenomics next-generation sequencing; rhino-orbital-cerebral mucormycosis.

Figure 1

Physical examination and CT image of the patient during administration. The ocular signs of physical examination on day 1 after admission (A–C). The orbital CT image on day 1 after admission showed bilateral maxillary and ethmoid sinusitis (D). The head CT image on day 3 after admission showed swelling of soft tissue around the right orbit, slightly aggravated compared to the first day after admission (E). The head CT image on day 4 after admission showed a low-density shadow in the bilateral frontal lobe and right anterior horn of the lateral ventricle (F).

Figure 2

Coverage of Rhizopus arrhizus detected by mNGS in a blood sample.