A Stormy Case of Rhinocerebral Mucormycosis, and A Recovery Against All Odds (P2.323)

Objective: A case of Rhino-Orbito-Cerebral Mucormycosis is presented, which led to extreme neurological complications and facial disfigurementin a young woman. We explore the reasons for our patient’s recovery, and her progress a year on.

Background: A 22 year old diabetic woman presented in September 2015 with altered mental status, right blindness and diabetic ketoacidosis. CT showed a soft tissue mass in her nasal cavity. Biopsy confirmed a Zygomyces infection.

Design/Methods: She was started on Amphotericin/ Posaconazole and underwent multiple debridements of her right facial structures, ultimately leading to removal of her right eye and all soft tissues from her right orbit to her oropharynx. Admission scans showed restricted diffusion along the course of the right Trigeminal Nerve, with meningeal and vasculitic spread of infection intracranially. She progressed to complete occlusion of the right internal carotid artery with watershed infarcts and a progressive dense left hemiplegia. Confluent abscesses evolved from her right frontal lobe to the cerebellum. Cavernous sinus thrombosis ensued. Mass effect from abscess, infarction and edema, led to obstructive hydrocephalus with tonsillar ectopia. She underwent a suboccipital craniectomy to drain the intracranial abscess, and shunting to relieve the hydrocephalus. Repeated brain imaging shows stable enhancement of brainstem and cerebellum. Suppressive antifungal treatment continues.

Results: We can display a video showing how this patient’s multidisciplinary hospital care, family and an excellent rehabilitation facility helped her recover from near-certain fatal complications. A year onwards, our patient is at home with her family. She has recovered 3+/5 power on the left side. She has intact cognition and finds pleasure in music. She uses her I Pad and plays with her daughter. She is aware of her disfigurement, but appears optimistic for reconstructive surgery.

Conclusions: Little is understood about how to predict neurological recovery after devastating injury. Aggressive care, psychological factors and determination may play a role.

Disclosure: Dr. Zafar has nothing to disclose. Dr. Prabhu has nothing to disclose. Dr. Newman has nothing to disclose. Dr. Yaddanapudi has nothing to disclose.