Disseminated mucormycosis with pericardial involvement: A case report

Abstract

Background

Mucormycosis is an invasive fungal infection most commonly seen in immune compromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immune competent individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient with disseminated Mucormycosis who presented as rhino orbital Mucor mycosis with pericardial involvement.

Case summary

A 17-year-old female presented with intermittent high-grade fever of 1 month duration. She was diagnosed as Rhino orbital Mucormycosis as evidenced by MRI brain and orbits and biopsy of maxillary sinus. Patient underwent left endoscopic debridement of sinuses and left endoscopic Denker's procedure with left orbital decompression and was treated with Amphotericin B subsequently. During the course of hospitalisation, patient developed large pericardial effusion with cardiac tamponade secondary to invasive mucor infection as evidenced by pericardial fluid culture.

Conclusion

Disseminated Mucor mycosis is a rare condition that involves two or more non-contiguous organ systems. Disseminated Mucor mycosis is the least common and the worst prognosis type, and it mostly starts with lesions in the lungs and then disseminates to other sites. Cardiac dissemination of rhino orbital Mucor mycosis, like in our case, is unusual and often diagnosed post-mortem; an antemortem diagnosis is very rare. Cardiac involvement is a rare, yet fatal, complication that can occur in disseminated disease and a strong index of suspicion is necessary for prompt treatment, especially in high-risk patients.