The Rhino Without It's Sugar (P2.324)

We present a case of a non-diabetic patient with stroke like symptoms that was determined to be due to mucormycosis invading the sphenoid sinus.A 64 year old female was admitted for slurred speech and right-sided weakness. She was brought to the ER after being found unresponsive. Family members stated she had been experiencing difficulty speaking, and mild right facial weakness. She has been complaining of headaches for the past seven months and 15 pound weight loss. On admission, temperature was 98.4°F, BP 122/77, PR 78, and RR 18. Exam was significant for right-sided facial asymmetry/droop, expressive aphasia, and slurred speech. Labs were significant for an ESR of 72mm/hr. Head CT showed low attenuation mass in the left basal ganglia, suspicious for developing infarct and a partial opacification of the left sphenoid sinus. The patient was started on aspirin and levetiracetam. Brain MRI demonstrated a subacute stroke in the left basal ganglia and opacification of adjacent left sphenoid sinus with abnormal mucoperiosteal enhancment. Lumbar puncture was performed and CSF was cloudy, tested nonreactive for VDRL, WBC 245/c/mm, and protein 82mg/dl. Culture was negative for cryptococcal antigen. A repeat MRI showed inflammation of the middle cerebral artery consistent with vasculitis and a left sphenoid sinus opacification was extending to the brain along the left middle cerebral artery. She underwent sphenoid sinus biopsy which showed mucormycosis. Subsequently, she develope...
Source: Neurology - Category: Neurology Authors: Tags: Fungi, Parasites, and Other Pathogens Source Type: research