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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31820a530b
Case Reports

Rhinocerebral Mucormycosis in an Inpatient With Acquired Immunodeficiency Syndrome: A Complication of Therapy?

Idoko, Kimberly E. MD; Gomez, Isabel MD; Sharma, Puneeta MD

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Abstract

Mucormycosis is an often fatal fungal infection with increasing incidence that occurs in immunocompromised patients after inhalation of Mucorales spores into the nasal and oral mucosa. Although exceptionally rare in patients with acquired immunodeficiency syndrome (AIDS) by virtue of their relatively preserved neutrophil function, mucormycosis is a very relevant consideration in the AIDS population given that other opportunistic infections such as intracranial toxoplasmosis and Pneumocystis pneumonia, which are common in the setting of AIDS, often require therapies that put these patients at increased risk for mucormycosis. For survival to be a possibility, mucormycosis must be rapidly diagnosed and promptly and aggressively treated with surgical debridement and intravenous antifungal medication. We report a case of rhinocerebral mucormycosis in an AIDS inpatient who underwent pyrimethamine/clindamycin therapy with short-term dexamethasone for treatment of presumed intracranial toxoplasmosis complicated by cerebral edema. Such therapy was concurrent with dapsone therapy for Pneumocystis jirovecii pneumonia prophylaxis in the setting of sulfa allergy, which underscores the need for general medicine practitioners who are the primary caretakers of AIDS patients in the inpatient setting to be keenly aware of mucormycosis and its presentation, especially in its most predominant rhinocerebral form.

© 2011 Lippincott Williams & Wilkins, Inc.

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